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THE SINGLE CONNECTION 100 MORNINGSIDE ROAD, EDINBURGH. EH10 4BY Telephone: 0131 478 4423 e-mail: singleconnection @ blueyonder.co.uk www.singleconnection.co.uk |
MEMBERSHIP APPLICATION FORM |
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| Please print | |||||||||||
| Full Name (as you wish to be addressed): _________________________________________________ |
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| Address: ___________________________________________________________________________ |
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| Town: __________________________________ |
Postal Code: _____________________________ |
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| Tel No: __________________________________ |
Mobile: __________________________________ |
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| Date of Birth: _____/_____/_____ |
Male/Female: ____ |
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| Email (for Newsletter by e-mail, available after trial period): __________________________________ |
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| Occupation: _____________________________ |
Interests: ________________________________ |
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| ___________________________________________________________________________________ |
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| How did you first hear about the SINGLE CONNECTION? (please tick) |
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| Through a Club Member (please specify) ________________________________________________ | |||||||||||
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Other _____________________________________________________________________________ |
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| FEES: 6 Week Trial -£15. Full Membership by Standing Order - £12 per month. | |||||||||||
| Full membership by cash or cheque - £45 for 3 months, £75 for 6 months or £145 per year. |
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| PLEASE READ BEFORE SIGNING, THEN SUBMIT FORM WITH PAYMENT: | |||||||||||
| I am not living with a spouse, nor in a similar relationship. I promise to treat all other members with every respect. I will not indulge in excessive drinking. I do not have a criminal record. I understand that any information about myself is to be treated in confidence and only passed to others with my permission. |
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| The owner, Marjory Lawrie, reserves the right to refuse, suspend or cancel membership without giving reasons. Participation in all Single Connection events is entirely at your own risk and no liability will be accepted by the owner. |
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| Signed: ____________________________________________________ Date: _____/_____/_____ |
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