MEMBERSHIP APPLICATION FORM

Hon Secretary: Rod Farley. Rojofar@btinternet.com

Data Protection Officer: John Rice, JohnRice.Probus@outlook.com
MEMBERSHIP APPLICATION FORM

Haywards Heath & District Probus Club
YOUR FULL NAME: (IN CAPITALS PLEASE)*
YOUR DATE OF BIRTH*

DayMonthYear
Date
NAME OF SPOUSE/PARTNER (OPTIONAL)
YOUR HOME ADDRESS*
POST CODE*
TELEPHONE NUMBER*

Area CodePhone Number
MOBILE NUMBER
EMAIL ADDRESS
example@example.com
HOBBIES/INTERESTS*
BEFORE YOU RETIRED, WHAT WORK DID YOU DO?*
ANY OTHER INFORMATION REQUESTS OR DIETARY REQUIREMENTS
I hereby apply for membership of the Haywards Heath & District Probus Club, and if accepted: (a) I agree to abide by the Club's Rules; and (b) I agree, if requested, to take part in the running of the Club: and (c) I further acknowledge that I have read the Club Rules and the General Data Protection Regulations overleaf. as applicable to the Club.
Please click here to agree*

I AGREE
Date*

DayMonthYear
Date
Should be Empty: