The Regent
Sports & Social Club
APPLICATION FOR MEMBERSHIP 2015 / 16
Please complete in BLOCK CAPITALS
FULL NAME
HOME ADDRESS
Postcode
Phone
e-mail
All membership details are held in accordance with the requirements of the Data Protection Act and
will only be used for Club business. They will not be disclosed to any other parties.
Renewals from last year
Membership renewal – please tick
Applicants who have held Associate Membership for at least three full and
continuous years may apply for Full Membership by ticking this box
New / Lapsed Members
Associate Membership Application – please tick
All Applicants
I enclose £12.00* (£10 + £2 VAT) being the current membership fee for the period to 30th
September 2016. Cheques should be made payable to “The Regent Sports & Social Club”.
* Special Offer of £9 (£7.50 + £1.50 VAT) if application is received before 31st October 2015
I hereby apply for membership of The Regent Sports & Social Club and confirm that I am
over 18 years of age. I agree to abide by the Constitution and Rules of the Club.
Signed …………………………………………………
Date………………………..
Please return this form with payment to The Membership Secretary, Regent Sports & Social
Club, 102 Regent Road, Leicester. LE1 7DA.
Or apply on line – e-mail this completed form to the club, and send payment online to account
29624653 sort code 05:05:60, quoting your name as reference Please note this is a new
account from Nov 2015
When processed, membership cards may be collected from the bar or can be posted to you if
you supply a SAE.
Main use / interests at The Regent – please tick all that apply:
Tigers games
City games
Darts
Snooker
Table Tennis
Weekday lunch
Quizzes
Functions
Jazz
Other (please specify):
FOR OFFICE USE ONLY:
Membership: full / associate
Crib
Pool
Date Payment Received:
Approved by:………………
Membership number:……………