To subscribe, fill up the online subscription form and our Customer Service Representative will contact you within one working day.

Salutation:*	Mr Ms Mrs Mdm Dr
Name:*
NRIC Number:*
Date Of Birth:*
Contact Number (Home):*
Contact Number (Mobile):*
Address (For Billing):*
Address (For Installation, If Different From Above):*
Email Address:*
I wish to subscribe to the following broadcast service plan (Please Select):*	24 Months Plan + 9 Months Bonus $385.20 ($11.67/mth) 12 Months Plan + 3 Months Bonus $192.60 ($12.84/mth) ULIVE Promo! 24 Months Plan + 13 Months Bonus $385.20 ($11.67/mth) ULIVE Promo! 12 Months Plan + 6 Months Bonus $192.60 ($12.84/mth) MDIS Alumni Members (10% OFF!) - 24 Months Plan + 9 Months Bonus at $346.68 ($10.50/mth) MDIS Alumni Members (10% OFF!) - 12 Months Plan + 3 Months Bonus at $173.34 ($11.55/mth) MDIS Ordinary Members (5% OFF!) - 24 Months Plan + 9 Months Bonus at $365.94 ($11.09/mth) MDIS Ordinary Member (5% OFF!) - 12 Months Plan + 3 Months Bonus at $182.97 ($12.20/mth)
MDIS Membership Number:
Payment Mode:*	Cheque (Payable to REDIFFUSION PTE LTD) Credit Card Cheque (Payable to REDIFFUSION PTE LTD)
Verification No.:*
	I have read the Terms & Conditions

*Note: Prices reflected for MDIS Members' plans are after discount.

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