Registration Form

Personal Details = required

Full Name

Home Address

Home Phone

Work/Other Phone

Mobile Phone

Email Address

Alternate Email

Date of Birth

Gender

Male Female

Occupation

(Please indicate if you would be willing to help the club should it need your expertise.)

Membership Start

When would you like your membership to start?

As Soon As Possible Specific Date

Preferred Start Date
(if applicable)

Membership Category

Please select your preferred membership category

	Category	Cost
	Adult Adult Membership Only available to Female only over the age of 18.	£7.50

Data Protection

I understand that any personal data I provide on this site will be processed in accordance with the Terms & Conditions and Privacy Policy. I have read and agree to the Terms & Conditions (https://www.myclubhouse.co.uk/SmileyPaces/Home/TermsAndConditions) and the Privacy Policy (https://www.myclubhouse.co.uk/SmileyPaces/PrivacyPolicy;).

Signature

Date

Please return completed forms to:

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