Single Membership - Southern Parishes Conservative Club

Name *

First

Last

I/We am/are applying to become member/s of the above Club, declare I/we are not less than eighteen years of age, am/are a Conservative, not owing any allegiance to any other political party and I/we do not belong to any Liberal, Radical, Socialist or Labour Party. *

Please tick if you acknowledge the above statement

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Telephone Number *

Email *

Email Marketing

We send regular emails to keep members informed about the latest upcoming events, news and membership renewal.

Please tick this box if you are happy to receive our emails.

If you agree to receive emails, you can unsubscribe from these emails at any time by clicking the link in the footer of our emails. For information about privacy practice, please visit our website. We use MailChimp as our email marketing platform. By ticking this box, you also acknowledge that your information will be passed on to MailChimp for processing and that you are happy to receive emails from Southern Parishes Conservative Club about upcoming events, news and membership renewal.

Photo Consent

We take the issue of data protection very seriously and would never knowingly use an image of you without your prior consent. We would, therefore, ask you to read through the following information and confirm whether you are happy to use photos if you. I understand that this image will only be used for the following purposes:  Southern Parishes Conservative Club electronic (including website) and printed information, displays, advertising or other media activities (including the Internet and social media I understand that this image will NOT be used for:  Anything that may cause offence, embarrassment or distress, I understand that this image may continue to be used until I advise otherwise. This consent is given in perpetuity and does not require prior approval by me

I give consent for photo to be used
I do not give consent for my photo to be used

Membership Type

Let us know which type of joint membership you are applying for. Please be aware we charge a £10 joining fee on top of the membership price. This joining fee does not apply to membership renewals.

Membership type *

Single Membership
Senior Citizen (65+)
Affiliation Card
Party Subscription

Payment option *

Pay by card (at the bar)
Annual standing order

Please let us know how you would like to pay for your membership.

For office use only

Membership paid for
Membership card sent

Proposer 1

First

Last

Membership number

Signature

Proposer 2

First

Last

Membership number

Signature

Numbers