Application

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Please note that all sections must be completed for this application to be submitted to the Committee. Any application missing information will be deemed incomplete and therefore not to be considered. Memberships are for the applicant and their partner living at the same address.

All potential members should be aware that we do not accept membership applications through third parties – including any agencies or concierges – or social media accounts. The only way to apply for membership is with the club directly, via this website.

OΠWɅRDS

I WɅΠT TO BE Ʌ MEMBER OF ΠYX

LOCɅTIOΠ(Required)

OΠWɅRDS

MY ΠΛME IS

Title(Required)

FIRST ΠΛME(Required)

SURΠΛME(Required)

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I ΛM

GEΠDER(Required)

ΛΠD I WAS BORΠ OΠ

01(Required)

1982(Required)

OΠWɅRDS

I LIVE ΛT

ΛDDRESS LIΠE 1(Required)

,

ΛDDRESS LIΠE 2(Required)

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WHICH IS IΠ

CITY / TOWΠ(Required)

,

COUΠTRY(Required)

.

POSTΛL CODE / ZIPCODE(Required)

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YOU CΛΠ REΛCH ME ΛT

+123 45 678 9100(Required)

and

name@email.com(Required)

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OΠWɅRDS

I WORК IΠ THE

Occupation(Required)

IΠDUSTRY

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FOR

COMPΛΠY NΛME(Required)

OΠWɅRDS

PLEɅSE UPLOɅD Ʌ CLEɅR, RECEΠT PORTRAIT OF YOURSELF

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Files should be jpg or png and under 10MB.

Photo(Required)

Max. file size: 10 MB.

OΠWɅRDS

MY PROPOSER IS

Title(Required)

FIRST ΠΛME(Required)

SURΠΛME(Required)

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Your proposer needs to be a current member of the club.

OΠWɅRDS

PREPɅRE TO STEP IΠTO THE ΠIGHT…

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MEMBERSHIP LOCɅTIOΠ

{:17:value}

TITLE

{:24:value}

ΠΛME

{:25:value}

SURΠΛME

{:26:value}

GEΠDER

{:27:value}

DΛTE OF BIRTH

{:29:value} {:30:value} {:31:value}

ΛDDRESS LIΠE 1

{:36:value}

ΛDDRESS LIΠE 2

{:37:value}

POSTΛL CODE / ZIPCODE

{:45:value}

MOBILE ΠUMBER

{:48:value}

EMΛIL ΛDDRESS

{:50:value}

OCCUPΛTION

{:56:value}

COMPΛΠY

{:55:value}

PROPOSER TITLE

{:60:value}

ΠΛME

{:61:value}

SURΠΛME

{:62:value}

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The information provided will be treated with maximum confidentiality and shall not be disclosed to any other party. Once the form is submitted, you will receive an automated email receipt.