Choice Privileges® -- Membership Application

To join the Choice Privileges rewards program, please fill in the form below. Click the "Submit Application" button once at the bottom to receive your member number. Your membership will be activated automatically.

If you have questions about the program or prefer to speak to a Choice Privileges representative please call the Choice Service Center.

In case we need to contact you for further information, please fill in at least one phone number. Required fields are indicated with an asterisk (*).

Name Information
Title:
*First:   MI:
*Last:

Applications are for individuals only (couples, corporations, or other entities are not eligible for membership). Must be 18 to apply.
Home Address
*Address:
 
 
*City/Suburb:
If your address contains a district number, please add it to the city's name.
*State:
*Postal Code (ZIP):
*Country:
County:
Company Name
Company Name:
Corporate Client Information
Corporate ID #:
Business Address
Address:
 
 
City/Suburb:
If your address contains a district number, please add it to the city's name.
State:
Postal Code (ZIP):
Country:
County:
Primary Address
Primary Address:
Contact Information
 For phone numbers outside of the U.S. and Canada, please include the international dialing code.
Home Phone:
Business Phone:   ext.  
Fax Number:   ext.  
* E-mail Address:
* Confirm E-mail Address:
Online Profile Access
Why Do I Need a User Name and Password?
* User Name:
   (Minimum 6 characters)
* Password:
   (Minimum 6 characters)
* Confirm Password:
Personal Information and Preferences
Birthday:
Children 18 and under:
Smoking Preference:
Bed Preferences:
Bed Preferences:
Questionnaire (Optional)
How did you hear about the Choice Privileges program?
 

After filling out the form, click the "Submit Application" button ONCE and wait for a reply.