2009/10 COUPLES 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.

COUPLES MEMBERSHIP £250 + VAT

Prefix

Prefix		Prefix
Name		Name
Email	Please complete to receive the 29 Newsletter	Email	Please complete to receive the 29 Newsletter
Daytime Tel		Daytime Tel
Mobile		Mobile
Date Of Birth	(29 is aimed at members aged 30yrs & over)	Date Of Birth	(29 Membership is aimed at individuals of 30 yrs and over)
Occupation		Occupation
Hobbies & Interests		Hobbies & Interests
Upload a recent photo:		Upload a recent photo:

Address

Post Code

Home Address Business Address

Home Tel

Home Fax

Proposing Member

Membership Number

Additional Comments

We 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

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2009/10 COUPLES MEMBERSHIP APPLICATION FORM