Surname (required) Forename (required)
Address (required) Post Code (required)
Phone (required) Email (required)
Date of Birth (required) Marital Status (required) SingleMarriedSeparatedWidowedDivorced
Activities & Interests (required)
How did you hear about the club? (required)
Have you been a member of the club before? If so when? (required)
Why did you leave? (required)
Do you have a Criminal Conviction? YesNo Please be aware that there is a vetting process in place prior to ratification into the Club.
If you object to your telephone number being circulated to other members of the club YesNo
If you object to your e-mail address being circulated to other members of the club YesNo
The Club reserves the right to use photographs of Members for publicity purposes, eg website. If you object to your photo being used YesNo
Please supply a passport style photograph with this form. (Required for ID Purposes)
I understand this application does not bind me to any contract nor does it bind the organisers to acceptance of this application. I agree that if I become a member, I will abide by the Group’s Constitution, Rules and Policies.