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MEMBERSHIP RENEWAL FORM

THIS FORM ONLY NEEDS TO BE FILLED IN IF YOUR DETAILS HAVE CHANGED IN ANY WAY

ALL RENEWALS ARE NOW PROCESSED AT THE BAR.

PLEASE HAVE YOUR MEMBERSHIP CARD WITH YOU WHEN RENEWING

2012

(PLEASE USE CAPITAL LETTERS)

 
Surname  (Mr/Mrs/Ms) ………………………………………………

First Name(s)   …………………………………………………………

Address   ………………………………………………………………

…………………………..  Post Code   ……………………

e-mail address  …………………………………………………………

Telephone Number   ……………………………………………………

Date of Birth (Important for accurate records)   ………………………

Membership Number   ………………     Date …………………………

TYPE OF RENEWAL REQUIRED:

 Carlton House Club Membership Renewal  (Male/Female)    £ …………

(2012  £14.00)

With C.I.U 2012 Pass Card Renewal                     £ …………

(2012  £17.50)

(For those with C.I.U Associate Membership Card)

Other Items: …………………………                  £ ……………

(Lost Membership Card £2.00)

 TOTAL  £_________

Contact email     admin@carltonhouseclub.co.uk

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