VIP/Club Card Online Application

A * indicates a required field.

*Card Type

VIP Card Z Card	VIP Card $500.00 Z Card $175.00	Payment required once your application is approved.
Please fill out application below as best as possible. 72 hours for approval, picture I.D. required

* First Name

Middle Initial

* Last Name

Company

Title/Position

How long w/company

Military Info

What Branch/Rank

How long in service

Where are you stationed

Home Address

*Address

* City

* State

* Zip

* Country

Work Address

Address

City

State

Zip

Country

Please forward
correspondence to:

Home Work

Phone Numbers

* Home Phone (include area code)

* Work Phone (include area code)

Fax (include area code)

Birdthday

Month

Day

Year (Optional)

How long at prsent address

How long in Hawaii

Favorite Drink

Occupation

* E-mail Address

Please ask any questions you might have and/or add any comments.

How did you find out about Zanzabar Night Club?

Other Source - Please Specify:

Authorized representative for phone-in reservations (VIP Card members only): (Optional)
Name:Affiliation/Title:

By submitting this application, you acknowledge that above information is true and correct to the best of my knowledge. By pressing the Send Form button below, I indicate understanding and acceptance of the Zanzabar Rules and Regulations and Terms and Conditions of VIP/Z Card membership..
* I agree.