Register now

A note

To make the IKS member club fully operational we need at least 85 members so all legal fees and obligations can be covered. Right now we have registrations. Feel free to invite friends and family to join, so our goal can be reached in time.

Your advantages with the IKS member card:

IKS member card: THB 1.000,00 / valid 2 years
Receive all advantages of our Members for Members program (IKS members give you discounts on their products or services)
monthly info meeting
Red Cross 24 hours info service (information of ambulance and hospitals about your medical data and information of relatives in case of emergency)
more advantages to come...

Your personal data

Please fill out all fields in this section.

Family Name

Given Name

Date of birth (YYYY-MM-DD)

Gender

male female

Occupation

Email Address

Mobile Phone

Your health related data

The IKS member card will help you to relay information about your medical history to the hospitals, eg. if you are unable to speak for yourself. Please fill out as much as possible. This data will be made available to the hospital.

Notification in case of emergency

Name

Relationship to Card Holder

Telephone

Medical history

Blood Type

Allergies

Previous Surgeries

Permanent Sicknesses

Medicine Taken (permanent/temporary)

Further Notes regarding your medical history

Information about your health insurance

Fill in all information that is needed to use your health insurance, like Insurance ID, contacts, requirements aso.

Health Insurance

Your visa related data

If you want to use Herberts offers (eg. prepared forms for your visa trips) fill out this section as complete as possible.

City of Residence

Country of Residence

Address in Thailand

Passport Number

Place of Issue

Expiry of Passport (YYYY-MM-DD)

Place of birth

Current Visa Number

Visa Type

Visa valid until (YYYY-MM-DD)

Last entry to TH(YYYY-MM-DD)

Place of last entry

Further comments

Is there anything else you want to tell us?

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