Membership Application Form

Membership Number(Required)

Membership Type(Required)

Name

Title First Last

Age(Required)

Date of Birth

Gender(Required)

Address

Street Address Address Line 2 City / Town County Postcode

Mobile Phone Number(Required)

Work Telephone Number

Home Telephone Number

Email(Required)

Enter Email Confirm Email

Occupation(Required)

Additional Members

Name

Title First Last

Date of Birth

Gender

Relationship to Lead Member

Address

Street Address Address Line 2 City / Town County Postcode

Mobile Phone Number

Work Telephone Number

Home Telephone Number

Enter Email Confirm Email

Occupation

Payment Details

Duration of Membership Contract(Required)

Method of Initial Payment(Required)

Debit / Credit Card

Cash

Initial Payment Amount (£)(Required)

Amount (£ per month)

Additional Comments

I agree that I have paid the joining fee and received my joining guest passes(Required)

Yes I agree

I agree to pay Whittlebury Park Hotel & Spa a Direct Debit from the account detailed in the subsequent mandate. I understand that this instruction may remain with Whittlebury Park Hotel & Spa and if so, details will be passed electronically to my Bank/Building Society(Required)

Yes I agree

Please read and understand the Membership Terms and Conditions before signing. The Membership Terms and Conditions form part of this contract and in signing below you are accepting them. Please check your membership category and amounts payable before ticking each box

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Membership Application Form