The regent sports & social club

The Regent

Sports & Social Club

APPLICATION FOR MEMBERSHIP 2017 / 18
Please complete in BLOCK CAPITALS

FULL NAME
HOME ADDRESS
Postcode		Phone
e-mail

All membership details are held in accordance with the requirements of the Data Protection Act and will only be used for Club business. They will not be disclosed to any other parties.

Renewals from last year

	Membership renewal – please tick
	Applicants who have held Associate Membership for at least three full and continuous years may apply for Full Membership by ticking this box

New / Lapsed Members

Associate Membership Application – please tick

All Applicants

I enclose £12.00* (£10 + £2 VAT) being the current membership fee for the period to 30^th September 2018. Cheques should be made payable to “The Regent Sports & Social Club”.

* Special Offer of £10 (£ 8.33 + £1.66 VAT) if application is received before 31^st October 2017
I hereby apply for membership of The Regent Sports & Social Club and confirm that I am over 18 years of age. I agree to abide by the Constitution and Rules of the Club.


Signed ………………………………………………… Date………………………..
Please return this form with payment to The Membership Secretary, Regent Sports & Social Club, 102 Regent Road, Leicester. LE1 7DA.

Or apply on line – e-mail this completed form to the club, and send payment online to account 29624653 sort code 05:05:60, quoting your name as reference Please note this is a new account from Nov 2015

When processed, membership cards may be collected from the bar or can be posted to you if you supply a SAE.

Main use / interests at The Regent – please tick all that apply:
Tigers games	City games	Darts	Snooker	Table Tennis	Crib	Pool
Weekday lunch	Quizzes	Functions	Jazz	Other (please specify):

F
Date Payment Received:
OR OFFICE USE ONLY:

Membership: full / associate Approved by:……………… Membership number:……………