2009/10 MEMBERSHIP APPLICATION FORM

(Subject to approval by Membership Committee) Please complete the following form, there is a section below to upload a recent photo, max file size is 2mb. If you are having problems uploading an image please email us an attachment alongside your name.

PRIVATE MEMBERSHIP £150 + VAT

Two Year Membership - £250 + VAT

Prefix

Name

Comany Name

Address

Post Code

Home Address Business Address

*Email:

Please complete to receive the 29 Newsletter

Home Tel

Home Fax

Mobile

Day Tel

Date Of Birth

(29 Membership is aimed at individuals of 30 yrs and over)

Occupation

Hobbies & Interests

Proposing Member

Membership Number

Upload a recent photo:

Additional Comments

I have read the terms and condtions

Membership process normally takes 5 working days. Once your application has been approved we will contact you for payment