Membership Application
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APPLICATION FOR NEW MEMBERSHIP
FROM 1 January 2012 – 31 DECEMBER 2012
(PLEASE USE CAPITAL LETTERS)
Surname (Mr.Mrs.Ms.)………………………………………………………
First Name(s)……………………………………………………………………
Address…………………………………………………………………………….
………………………………………………………………………………………..
……………………………………………Post Code……………………………
E Mail Address………………………………………………………………………
Telephone No…………………………………..Date…………………………….
Date of Birth (Essential for Records)……………………………………..
Occupation………………………………..Signature…………………………..
Name of Proposer………………………………Member No………………..
Name of Seconder………………………………Member No……………….
MEMBERSHIP FEE TO 31 DECEMBER 2012
C. H. Club New Membership (Male/Female) £………………..(£18.00)
With C.I.U. Affiliated Membership £………………..(£25.00)
(FEE INCLUDES DOOR ENTRY & LOYALTY CARD)
TOTAL £……………………
Contact email admin@carltonhouseclub.co.uk
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