Full Name
(As appeared in NRIC)
NRIC No.
Age
Male
Female
Marital Status
Please Select
Single
Married
Others
Occupation
Address
Contact No.
(Handphone)
(Home)
(Office)
Email Address
Preferred Timing
Please Select
Aug 1st 2009 @ Ubi (PM)
Aug 1st 2009 @ Bukit Timah (PM)
Aug 2nd 2009 @ Ubi (AM)
Aug 2nd 2009 @ Ubi (PM)
Aug 2nd 2009 @ Bukit Timah (AM)
Aug 2nd 2009 @ Bukit Timah (PM)
Current Car Owned:
Year of Registraton:
Nissan Model you are interested in
How did you get to know of this campaign?
Please Select
Nissan website
Print
AsiaOne
Zuji
I agree to the
Terms and Conditions
for participation.
*Successful registers will be contacted by Tan Chong.
