AVLCI – Authorization Form

Authorization Form

AUTHORIZATION FORM

MEMBER'S INFORMATION

Full Name of Member (Last Name, First Name, Middle Initial, and/or Suffixes):

Full Name of Co-Member (Last Name, First Name, Middle Initial, and/or Suffixes):

Agreement Number:

Mobile Number:

Email Address:

AUTHORIZED GUEST'S INFORMATION

Full Name (Last Name, First Name, Middle Initial, and/or Suffixes):

Mobile Number:

Email Address:

Please specify the transaction that the authorized person is authorized to conduct on behalf of the member:

Choose a membership benefit:

Please specify:

Authorization Period:

Property Name:

Check-in:

Check-out:

MEMBER'S AUTHORIZATION

Please attach at least two (2) valid IDs with signatures of the member and authorized person, as applicable.

Choose File

I/We hereby confirm that the information provided above is true and correct and authorize the person named in this form to conduct the specified membership inquiry or transaction on my/our behalf.

By checking this, I declare that the information I have given is true, correct, and complete. I also hereby authorize AVLCI to collect my updated personal information, which is protected by RA 10173 or the Data Privacy Act of 2012.

For more information on how we handle personal information, click Privacy Policy.

Signature

Sign Here