Member No.

SUPERJUNIOR UNITEDPHILIPPINES
Thank you for your interest in joining Super Junior United Philippines! Please print this PDF and complete this form with black ink. Please write legibly and truthfully in print and keep erasures to minimum.

MEMBER INFORMATION

Last Name/Family Name/Surname

Given Name

Middle Initial
YYYY DD MM Please write the full 4-digit year and write two-digits for the month and day. (e.g. January 22, 2007: 2007 01 22)

1X1 ID Picture

Sex:
Nickname

Female Male

Date of Birth

Year

Month

Day

Home Address:
City Zip Code Place of Birth (Optional) Religion

E-MAIL ADDRESSES
E-mail address:
primary e-mail address (required) This must be frequently used

PHONE NUMBERS Home Phone Number:

Other Address:

EMERGENCY CONTACTS

Persons Name Relation

(fill only if applicable)

Mobile Number:
secondary e-mail address (optional)

Yahoo! ID
for Yahoo! Messenger Please write your most frequently used phone number first.

Other Contact Numbers:

Contact Numbers

(fill only if applicable)

ADDITIONAL QUESTIONS Favorite Super Junior Member

Language Spoken:

Tell us more about your self

Address of emergency contact Occupation: (required)

Favorite Artist (other than SJ)

Company/School: (required)

(write all that applies)

Thank you for taking time to complete this form. Please review all the fields and check for any errors or blank fields. By submitting this form, you agree that you will abide by the rules of the fan club and that you will participate actively. You also confirm that all the information in this form is accurate and free of any errors. We promise that your information will not be used irresponsibly.
Super Junior United Philippines is no way affiliated/connected with SM Entertainment or any other commercial organizations. It is an independent entity (for the time-being) that aims to support the Korean group Super Junior in all its endeavors.

Your Signature

Date Completed SUPERJUNIOR UNITEDPHILIPPINES