<%@ Page Language="C#" ContentType="text/html" ResponseEncoding="utf-8" %> :: :: AAA AAA Roadside Assistance Dubai, Road Assistance, Membership Form ::
APPLY FOR YOUR AAA MEMBERSHIP RIGHT AWAY !
 PLATINUM
AED750/-
 GOLD
AED500/-
SILVER
AED250/-
Name
:
Company
:
  
P.O. Box
:
  
Occupation
:
  
Nationality
:
  
Date of Birth
:
  
Tel.Off
:
  
Res
:
  
Email
:
  
Type of Car
:
  
Model
:
  
      Year of Manufacture :
Car Registration Number
;
   Expiry :
Driving License Number
:
   Expiry :
Mode of Payment ( Please select one of the following )
   
   
MASTER CARD :
VISA CARD
 :
           
I hereby authorise AAA to charge the following to my Card Number :
Credit Card Expires on ( Month & Year) :
Membership Fee : Dhs.
 
AAA UAE Office
AWIR, DUBAI
04 33 33 200
JEBEL ALI , DUBAI
04 88 71717
ABU DHABI
050 65 46 830
NORTHERN EMIRATES
050 45 78 366

M/s. AAA ROADSIDE ASSISTANCE
P.O.BOX 5692, DUBAI, UAE.
Tel: 04-3333200
Fax: 04 3200326