Charterhouse Club

For Joint & Family Membership Applications please include both adults’ details. Please check membership availability to see if your category is on the waiting list.

First Members Details

Membership Category Required:
Title:
Forename:
Surname:
Date of Birth:	(dd/mm/yyyy)
Address:


County:
Postcode:
Home tel:
Work tel:
Mobile:
Email:

Second Members Details (if applicable)

Membership Category Required:
Title:
Forename:
Surname:
Date of Birth:	(dd/mm/yyyy)
Address:


County:
Postcode:
Home tel:
Work tel:
Mobile:
Email:

Children – aged 5 to 15 years

Children aged 16 and over must complete their own form.
There is no charge for those under 5. Please make a request
after their 5th birthday if you wish to incorporate additional
children into your membership.

Details of Children to be included in Membership

First Child Full Name	First Childs Date of Birth
	(dd/mm/yyyy)

Second Child Full Name	Second Childs Date of Birth
	(dd/mm/yyyy)

Third Child Full Name	Third Childs Date of Birth
	(dd/mm/yyyy)

Fourth Child Full Name	Fourth Childs Date of Birth
	(dd/mm/yyyy)

Please indicate where you heard about us :

Please tick this box if you do not wish to receive correspondence from the Club by email.

I/We have read the Club’s Terms & Conditions of Membership and agree to abide by them.