“Aeroplan常旅客”申请表

(请用英文填写)

请注意：通过我办事处申请的会员卡均无密码，如需设置密码，请致电会员中心：1-866-689-8080或1-514-395-0300。

您也可通过网站www.aeroplan.com注册会员并设置个人密码。

Departure Date/出发日期 _________________

Language of correspondence/选择语言       English/英语            French/法语

Gender/性别                       Male/男                    Female/女

First Name/名_________________Last Name/姓__________________

Date of Birth/出生日期        Day/日____Monty/月_____Year/年______

Company Name/公司_________________Business Title/职位______________

Mailing address/邮寄地址__________________________________

_____________________________________________________________

____________________________________________________________________

City and Province/城市及省份__________________Country/国家_________

Postal  Code/邮政编码____________

Telephone/电话_____________________Fax/传真______________________

E-mail address/电子邮箱地址__________________________________________

Signature/签署_______________________Date/日期_____________________

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以下为加航填写

卡号  AC______________________

（请在办理登机手续时向加航工作人员告知您的卡号以便累计里程）