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Renewal Form

Renewal Form

Membership Number

Member's Name

Please attach passport size photo

Email Address

Expiry Date

Family Membership Number (If renewing Family Membership)

I consent to allow The Grassroots’ Club to share my personal details with PA or any other organization to verify my Grassroots Leader status.

Membership Fees

Membership Type

Number of Years

*Kindly Tick the appropriate Membership Years.

Principle Membership

1 Year - $1202 Year - $2003 Year - $2405 Year - $300

Principle Membership With Family Membership

1 Year - $1602 Year - $2603 Year - $3305 Year - $450

Youth (15 to 35 Years old)/Senior (65 Years old & above) Membership

1 Year - $60

Youth (15 to 35 Years old)/Senior (65 Years old & above) Membership With Family Membership

1 Year - $100

PA Staff

1 Year - $60

PA Staff With Family Membership

1 Year - $100

Vehicle No.

*Please update if there is any changes in vehicle number and/or IU number.

Car plate Number

IU Number

Please Upload Log card

Spouse Vehicle No.

*Only Applicable if spouse has family membership.

Car plate Number

IU Number

Please Upload Log card

By Checking the following checkbox, you agreed to the following Terms and Conditions below I, hereby confirm that the above information is true and complete I consent to allow The Grassroots’ Club to send marketing information about their goods or services including notifying me of their marketing events, initiatives and promotions, lucky draws, membership, rewards schemes and other promotions. I, agree to comply with and be bound by the Constitution, Bye-laws and Rules & Regulations of the Club.

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