Basic details
Name
*
First Name
Last Name
Title
*
Decorations
E-mail
*
example@example.com
Telephone (If you do not have one please state your mobile twice)
*
Please enter a valid phone number.
Format: (00000) 000 000.
Mobile
*
Please enter a valid phone number.
Format: (00) 000000000.
Personal Address
*
Street Address
Street Address Line 2
City
County
Postal Code
Business Address
Street Address
Street Address Line 2
City
County
Postal Code
Business email
example@example.com
Name of your spouse or partner
First Name
Last Name
If your spouse or partner wishes to apply for 'additional' membership, they must complete their own application. If this field does not apply to you, please ignore it and move to the next step.
Which membership are you interested in?
Please Select
Ara
Orion
Aquarius
Business Membership
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Personal information
Please take a photo of yourself
Nationality
*
Date of birth
*
-
Month
-
Day
Year
Date
Personal qualifications
*
A short summery of your career and current occupation
*
Interests
*
Why do you want to join club Quantum?
*
Please list any other clubs you belong to
Supporting charities
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Please Note:
As a potential member, you are encouraged to meet with a membership advisor. Please telephone our clubs direct number or email both of which can be found on our "contact" page.
membership@clubsquantum.com to arrange a meeting. Virtual meetings are available to potential members who may not be able to come into the club for any given reason.
The club reserves the right to verify all/any information provided by applicants.
The club wholly reserves the right not to proceed with any application that the club board considers unsuitable. No explanation will be given upon refusal of an applicant.
All members are required to pay by direct debit.
Once an application for membership is submitted you agree to adhere to the club rules in accordance with the document named "Club House Rules" and any existing or additional codes of conduct enforced from time to time. You confirm that:
You have read a copy of the current Club House rules, codes of conduct and privacy notice.
You agree to follow any changes permanent or non-permanent made to the Club House Rules and/or Codes of Conduct.
You agree that The Company can use your personal information when processing your application and to verify your identity and/or any reasons given in the Privacy Notice.
You are 21 years+ of age.
All information provided in your application form is accurate and true.
If you qualify as a member you will pay the joining fee and annual subscription at the amount in accordance to your chosen membership and swiftly submit a completed direct debit form for future annual subscriptions.
You may cancel your membership within 14 days from your direct debit payment start date. Further information can be found in the Club House Rules.
Signature
*
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