Social Club Membership Application

Complete this on-line form to apply for membership to the Social Club, you will be notified of the Committee's decision and of the appropriate membership fee to be paid.
If you have any problems with this form, contact 07920 104064, or
email: club@stmarysbeeston.org.uk

Fields indicated by * are mandatory.
Forename *

Enter your first name

Surname *

Enter your surname

Address Line 1 *

House No and Street Name

Address Line 2

City *

Enter City, Town or Village

Postcode *

Enter Postcode

Phone No

Enter phone no inc dialling code

Mobile No

Enter your mobile no if you wish

Email address *

Enter your email address

Email Distribution List



Tick if you do NOT want to be on the club distribution list

Electoral Roll



Are you on the Parish Electoral Roll?

Proposer *

The Committe will contact your Proposer

Seconder *

The Committee will contact your Seconder

Agreement




Tick the boxes