{"id":632,"date":"2026-04-03T02:54:55","date_gmt":"2026-04-03T02:54:55","guid":{"rendered":"https:\/\/ioniawebdesign5.com\/ins\/?page_id=632"},"modified":"2026-04-03T02:55:52","modified_gmt":"2026-04-03T02:55:52","slug":"member-registration-form","status":"publish","type":"page","link":"https:\/\/ioniawebdesign5.com\/ins\/member-registration-form\/","title":{"rendered":"Member Registration Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"632\" class=\"elementor elementor-632\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b694488 e-flex e-con-boxed e-con e-parent\" data-id=\"b694488\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8a640b8 elementor-widget elementor-widget-heading\" data-id=\"8a640b8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Membership Registration<\/h1>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-2cea3ce e-flex e-con-boxed e-con e-parent\" data-id=\"2cea3ce\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-92dd058 elementor-widget elementor-widget-shortcode\" data-id=\"92dd058\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">        <div class=\"arm-member-wrapper\">\r\n            <div class=\"arm-member-container\">\r\n                                    <h2 class=\"arm-member-title\">Membership Registration Form<\/h2>\r\n                                \r\n                <form id=\"arm-member-form\" class=\"arm-form\" method=\"post\">\r\n                    <input type=\"hidden\" id=\"nonce\" name=\"nonce\" value=\"4e86fdaac1\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/ins\/wp-json\/wp\/v2\/pages\/632\" \/>                    \r\n                    <!-- Personal Information -->\r\n                    <div class=\"arm-form-section\">\r\n                        <h3>Personal Information<\/h3>\r\n                        \r\n                        <div class=\"arm-form-row\">\r\n                            <label for=\"member_name\" class=\"arm-label\">\r\n                                Full Name (as per NRIC) <span class=\"required\">*<\/span>\r\n                            <\/label>\r\n                            <input type=\"text\" id=\"member_name\" name=\"member_name\" class=\"arm-input\" required>\r\n                        <\/div>\r\n                        \r\n                        <div class=\"arm-form-row arm-form-row-inline\">\r\n                            <div class=\"arm-form-col-6\">\r\n                                <label for=\"member_nric\" class=\"arm-label\">\r\n                                    NRIC No. <span class=\"required\">*<\/span>\r\n                                <\/label>\r\n                                <input type=\"text\" id=\"member_nric\" name=\"member_nric\" class=\"arm-input\" required>\r\n                            <\/div>\r\n                            <div class=\"arm-form-col-6\">\r\n                                <label class=\"arm-label\">Membership Type <span class=\"required\">*<\/span><\/label>\r\n                                <div class=\"arm-radio-group\">\r\n                                    <label class=\"arm-radio-label\">\r\n                                        <input type=\"radio\" name=\"subscription_type\" value=\"new\" required>\r\n                                        <span>New Member<\/span>\r\n                                    <\/label>\r\n                                    <label class=\"arm-radio-label\">\r\n                                        <input type=\"radio\" name=\"subscription_type\" value=\"renewal\">\r\n                                        <span>Renewal<\/span>\r\n                                    <\/label>\r\n                                <\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n                        \r\n                        <div class=\"arm-form-row arm-form-row-inline\">\r\n                            <div class=\"arm-form-col-6\">\r\n                                <label for=\"member_dob\" class=\"arm-label\">\r\n                                    Date of Birth <span class=\"required\">*<\/span>\r\n                                <\/label>\r\n                                <input type=\"date\" id=\"member_dob\" name=\"member_dob\" class=\"arm-input\" required>\r\n                            <\/div>\r\n                            <div class=\"arm-form-col-6\">\r\n                                <label class=\"arm-label\">Gender <span class=\"required\">*<\/span><\/label>\r\n                                <div class=\"arm-radio-group\">\r\n                                    <label class=\"arm-radio-label\">\r\n                                        <input type=\"radio\" name=\"gender\" value=\"male\" required>\r\n                                        <span>Male<\/span>\r\n                                    <\/label>\r\n                                    <label class=\"arm-radio-label\">\r\n                                        <input type=\"radio\" name=\"gender\" value=\"female\">\r\n                                        <span>Female<\/span>\r\n                                    <\/label>\r\n                                <\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n                        \r\n                        <div class=\"arm-form-row arm-form-row-inline\">\r\n                            <div class=\"arm-form-col-6\">\r\n                                <label for=\"member_profession\" class=\"arm-label\">Profession<\/label>\r\n                                <input type=\"text\" id=\"member_profession\" name=\"member_profession\" class=\"arm-input\">\r\n                            <\/div>\r\n                            <div class=\"arm-form-col-6\">\r\n                                <label for=\"member_religion\" class=\"arm-label\">Religion<\/label>\r\n                                <input type=\"text\" id=\"member_religion\" name=\"member_religion\" class=\"arm-input\">\r\n                            <\/div>\r\n                        <\/div>\r\n                        \r\n                        <div class=\"arm-form-row\">\r\n                            <label for=\"member_language\" class=\"arm-label\">Language<\/label>\r\n                            <input type=\"text\" id=\"member_language\" name=\"member_language\" class=\"arm-input\">\r\n                        <\/div>\r\n                        \r\n                        <div class=\"arm-form-row\">\r\n                            <label for=\"member_address\" class=\"arm-label\">\r\n                                Residential Address <span class=\"required\">*<\/span>\r\n                            <\/label>\r\n                            <textarea id=\"member_address\" name=\"member_address\" class=\"arm-textarea\" rows=\"3\" required><\/textarea>\r\n                        <\/div>\r\n                        \r\n                        <div class=\"arm-form-row arm-form-row-inline\">\r\n                            <div class=\"arm-form-col-4\">\r\n                                <label for=\"member_town\" class=\"arm-label\">\r\n                                    Town <span class=\"required\">*<\/span>\r\n                                <\/label>\r\n                                <input type=\"text\" id=\"member_town\" name=\"member_town\" class=\"arm-input\" required>\r\n                            <\/div>\r\n                            <div class=\"arm-form-col-4\">\r\n                                <label for=\"member_postal\" class=\"arm-label\">\r\n                                    Postal Code <span class=\"required\">*<\/span>\r\n                                <\/label>\r\n                                <input type=\"text\" id=\"member_postal\" name=\"member_postal\" class=\"arm-input\" required>\r\n                            <\/div>\r\n                            <div class=\"arm-form-col-4\">\r\n                                <label for=\"member_state\" class=\"arm-label\">\r\n                                    State <span class=\"required\">*<\/span>\r\n                                <\/label>\r\n                                <input type=\"text\" id=\"member_state\" name=\"member_state\" class=\"arm-input\" required>\r\n                            <\/div>\r\n                        <\/div>\r\n                        \r\n                        <div class=\"arm-form-row arm-form-row-inline\">\r\n                            <div class=\"arm-form-col-6\">\r\n                                <label for=\"member_phone\" class=\"arm-label\">Telephone (Work)<\/label>\r\n                                <input type=\"tel\" id=\"member_phone\" name=\"member_phone\" class=\"arm-input\">\r\n                            <\/div>\r\n                            <div class=\"arm-form-col-6\">\r\n                                <label for=\"member_mobile\" class=\"arm-label\">\r\n                                    Mobile <span class=\"required\">*<\/span>\r\n                                <\/label>\r\n                                <input type=\"tel\" id=\"member_mobile\" name=\"member_mobile\" class=\"arm-input\" required>\r\n                            <\/div>\r\n                        <\/div>\r\n                        \r\n                        <div class=\"arm-form-row\">\r\n                            <label for=\"member_email\" class=\"arm-label\">\r\n                                Email <span class=\"required\">*<\/span>\r\n                            <\/label>\r\n                            <input type=\"email\" id=\"member_email\" name=\"member_email\" class=\"arm-input\" required>\r\n                        <\/div>\r\n                        \r\n                        <div class=\"arm-form-row\">\r\n                            <label class=\"arm-label\">Race <span class=\"required\">*<\/span><\/label>\r\n                            <div class=\"arm-radio-group\">\r\n                                <label class=\"arm-radio-label\">\r\n                                    <input type=\"radio\" name=\"race\" value=\"malay\" required>\r\n                                    <span>Malay<\/span>\r\n                                <\/label>\r\n                                <label class=\"arm-radio-label\">\r\n                                    <input type=\"radio\" name=\"race\" value=\"chinese\">\r\n                                    <span>Chinese<\/span>\r\n                                <\/label>\r\n                                <label class=\"arm-radio-label\">\r\n                                    <input type=\"radio\" name=\"race\" value=\"indian\">\r\n                                    <span>Indian<\/span>\r\n                                <\/label>\r\n                                <label class=\"arm-radio-label\">\r\n                                    <input type=\"radio\" name=\"race\" value=\"others\">\r\n                                    <span>Others<\/span>\r\n                                <\/label>\r\n                            <\/div>\r\n                        <\/div>\r\n                        \r\n                        <div class=\"arm-form-row\">\r\n                            <label class=\"arm-label\">Marital Status <span class=\"required\">*<\/span><\/label>\r\n                            <div class=\"arm-radio-group\">\r\n                                <label class=\"arm-radio-label\">\r\n                                    <input type=\"radio\" name=\"marital_status\" value=\"single\" required>\r\n                                    <span>Single<\/span>\r\n                                <\/label>\r\n                                <label class=\"arm-radio-label\">\r\n                                    <input type=\"radio\" name=\"marital_status\" value=\"married\">\r\n                                    <span>Married<\/span>\r\n                                <\/label>\r\n                                <label class=\"arm-radio-label\">\r\n                                    <input type=\"radio\" name=\"marital_status\" value=\"widowed\">\r\n                                    <span>Widowed<\/span>\r\n                                <\/label>\r\n                                <label class=\"arm-radio-label\">\r\n                                    <input type=\"radio\" name=\"marital_status\" value=\"divorced\">\r\n                                    <span>Divorced<\/span>\r\n                                <\/label>\r\n                            <\/div>\r\n                        <\/div>\r\n                    <\/div>\r\n                    \r\n                    <!-- Beneficiary Information -->\r\n                    <div class=\"arm-form-section\">\r\n                        <h3>Primary Beneficiary (for Family Protection Fund)<\/h3>\r\n                        \r\n                        <div class=\"arm-form-row\">\r\n                            <label for=\"beneficiary_name\" class=\"arm-label\">\r\n                                Name <span class=\"required\">*<\/span>\r\n                            <\/label>\r\n                            <input type=\"text\" id=\"beneficiary_name\" name=\"beneficiary_name\" class=\"arm-input\" required>\r\n                        <\/div>\r\n                        \r\n                        <div class=\"arm-form-row\">\r\n                            <label for=\"beneficiary_relationship\" class=\"arm-label\">\r\n                                Relationship <span class=\"required\">*<\/span>\r\n                            <\/label>\r\n                            <input type=\"text\" id=\"beneficiary_relationship\" name=\"beneficiary_relationship\" class=\"arm-input\" required>\r\n                        <\/div>\r\n                        \r\n                        <div class=\"arm-form-row arm-form-row-inline\">\r\n                            <div class=\"arm-form-col-6\">\r\n                                <label for=\"beneficiary_nric\" class=\"arm-label\">\r\n                                    NRIC \/ Passport <span class=\"required\">*<\/span>\r\n                                <\/label>\r\n                                <input type=\"text\" id=\"beneficiary_nric\" name=\"beneficiary_nric\" class=\"arm-input\" required>\r\n                            <\/div>\r\n                            <div class=\"arm-form-col-6\">\r\n                                <label for=\"beneficiary_mobile\" class=\"arm-label\">\r\n                                    Mobile <span class=\"required\">*<\/span>\r\n                                <\/label>\r\n                                <input type=\"tel\" id=\"beneficiary_mobile\" name=\"beneficiary_mobile\" class=\"arm-input\" required>\r\n                            <\/div>\r\n                        <\/div>\r\n                        \r\n                        <div class=\"arm-form-row\">\r\n                            <label for=\"beneficiary_allocation\" class=\"arm-label\">\r\n                                Allocation <span class=\"required\">*<\/span>\r\n                            <\/label>\r\n                            <input type=\"text\" id=\"beneficiary_allocation\" name=\"beneficiary_allocation\" class=\"arm-input\" value=\"100%\" required>\r\n                            <span class=\"arm-description\">Default: 100% or specify other percentage<\/span>\r\n                        <\/div>\r\n                    <\/div>\r\n                    \r\n                    <!-- Declarations -->\r\n                    <div class=\"arm-form-section\">\r\n                        <h3>Declarations<\/h3>\r\n                        \r\n                        <div class=\"arm-form-row\">\r\n                            <label class=\"arm-checkbox-label\">\r\n                                <input type=\"checkbox\" name=\"declaration_health\" value=\"1\" required>\r\n                                <span>\r\n                                    <strong>Health Declaration:<\/strong> I confirm I am between 18-70 years old and do not require medical underwriting.\r\n                                <\/span>\r\n                            <\/label>\r\n                        <\/div>\r\n                        \r\n                        <div class=\"arm-form-row\">\r\n                            <label class=\"arm-checkbox-label\">\r\n                                <input type=\"checkbox\" name=\"declaration_funds\" value=\"1\" required>\r\n                                <span>\r\n                                    <strong>Source of Funds:<\/strong> I confirm membership fees are from legitimate sources.\r\n                                <\/span>\r\n                            <\/label>\r\n                        <\/div>\r\n                        \r\n                        <div class=\"arm-form-row\">\r\n                            <label class=\"arm-checkbox-label\">\r\n                                <input type=\"checkbox\" name=\"declaration_legal\" value=\"1\" required>\r\n                                <span>\r\n                                    <strong>Legal Advice:<\/strong> I confirm I have received independent legal explanation on this membership's terms.\r\n                                <\/span>\r\n                            <\/label>\r\n                        <\/div>\r\n                        \r\n                        <div class=\"arm-form-row\">\r\n                            <label class=\"arm-checkbox-label\">\r\n                                <input type=\"checkbox\" name=\"declaration_general\" value=\"1\" required>\r\n                                <span>\r\n                                    <strong>General Declaration:<\/strong> I solemnly and sincerely declare that:\r\n                                    <ul style=\"margin: 10px 0 0 20px; list-style-type: disc;\">\r\n                                        <li>I have not been adjudged a bankrupt under the Insolvency Act 1967 (formerly the Bankruptcy Act 1967), and no bankruptcy petition has been filed against me.<\/li>\r\n                                        <li>I have no criminal record nor have I been charged or convicted in any Court of Law for any criminal offence involving fraud, dishonesty, or moral turpitude.<\/li>\r\n                                        <li>There is no pending litigation, arbitration, or administrative proceeding that would materially affect my standing or character.<\/li>\r\n                                        <li>I have made full and true disclosure of all material facts and have not concealed any information that might influence the approval of this application.<\/li>\r\n                                    <\/ul>\r\n                                <\/span>\r\n                            <\/label>\r\n                        <\/div>\r\n                    <\/div>\r\n                    \r\n                    <!-- Payment Information -->\r\n                    <div class=\"arm-form-section\">\r\n                        <h3>Payment Information<\/h3>\r\n                        \r\n                        <div class=\"arm-fee-display\">\r\n                            <div class=\"arm-fee-row\">\r\n                                <span class=\"arm-fee-label\">Membership Fee:<\/span>\r\n                                <span class=\"arm-fee-amount\">RM 2,888<\/span>\r\n                            <\/div>\r\n                        <\/div>\r\n                        \r\n                        <div class=\"arm-form-row\">\r\n                            <label for=\"promotion_code\" class=\"arm-label\">Promotion Code (Optional)<\/label>\r\n                            <div class=\"arm-promo-wrapper\">\r\n                                <input type=\"text\" id=\"promotion_code\" name=\"promotion_code\" class=\"arm-input\">\r\n                                <button type=\"button\" id=\"validate-promo-btn\" class=\"arm-button-secondary\">Validate<\/button>\r\n                            <\/div>\r\n                            <span id=\"promo-message\" class=\"arm-message\"><\/span>\r\n                        <\/div>\r\n                    <\/div>\r\n                    \r\n                    <div class=\"arm-form-actions\">\r\n                        <button type=\"submit\" id=\"member-submit-btn\" class=\"arm-button-primary\">\r\n                            Proceed to Payment\r\n                        <\/button>\r\n                    <\/div>\r\n                    \r\n                    <div id=\"arm-member-message\" class=\"arm-message\"><\/div>\r\n                <\/form>\r\n            <\/div>\r\n        <\/div>\r\n        <\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Membership Registration<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-632","page","type-page","status-publish","hentry"],"blocksy_meta":[],"_links":{"self":[{"href":"https:\/\/ioniawebdesign5.com\/ins\/wp-json\/wp\/v2\/pages\/632","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ioniawebdesign5.com\/ins\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/ioniawebdesign5.com\/ins\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/ioniawebdesign5.com\/ins\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/ioniawebdesign5.com\/ins\/wp-json\/wp\/v2\/comments?post=632"}],"version-history":[{"count":4,"href":"https:\/\/ioniawebdesign5.com\/ins\/wp-json\/wp\/v2\/pages\/632\/revisions"}],"predecessor-version":[{"id":637,"href":"https:\/\/ioniawebdesign5.com\/ins\/wp-json\/wp\/v2\/pages\/632\/revisions\/637"}],"wp:attachment":[{"href":"https:\/\/ioniawebdesign5.com\/ins\/wp-json\/wp\/v2\/media?parent=632"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}