• PLEASE READ APPLICATION INFORMATION AND ATTACHED ALL INSTRUCTIONS CAREFULLY.
• THIS AGREEMENT SHALL BE EFFECTIVE ONLY UPON ACCEPTANCE BY ATOMY (USA).

Do you or your spouse have Atomy membership in any other country?

( Atomy allows only one member ID to each individual in international and one member ID for you and your spouse )

YES NO

ATOMY MEMBER ID	( This member ID will be activated once upon verification by Atomy (USA) )
PASSWORD
NATIONALITY
	DOMESTIC RESIDENT INTERNATIONAL RESIDENT EXPIRY DATE expiry date (It should be remained more than 6 months and updated before expired or membership will be terminated)

APPLICANT’S NAME (as per NRIC or Passport)

LAST NAME		FIRST NAME
GENDER	FEMALE MALE
NRIC No/FIN No		DATE OF BIRTH
ADDRESS	POST CODE
E-MAIL
MOBILE		HOME PHONE

SPONSOR’S INFORMATION

ATOMY MEMBERSHIP ID
NAME
By signing below, I understand that my appointment does not make me an employee or legal representative of my sponsor or Atomy. I understand that my membership may be revoked if I fail to comply with Atomy's code of ethics and principle. In submitting this application, I hereby give consent for Atomy to collect, use and disclose my personal data for purposes connected to this application or to support my business or membership, which purpose may include disclosure of my personal data to other Atomy related corporations or entities that provide administration service to Atomy I hereby consent and certify that the information given above is true and correct.
APPLICANT’S NAME		SIGNATURE
DATE	When completed, please email or fax a copy of this application to Atomy (USA). It will takes about 2 -3 working days for acceptance and reply to you by e-mail or SMS.