18 6 3

A p p l i c At i o n f o r M e M b e r s h i p

4 0 D o V e r s t r e e t M AY F A i r l o n D o n W 1 s 4 n p

proposer AnD seconDer

Name of ProPoser

Name of secoNder

P l e a s e N ot e : 1. You should ask your proposer and seconder to write a letter in support of your application. these letters should be sent separately by them to the membership secretary. 2. If you do not know any member of the club well enough to propose or second your application please contact the membership secretary who may be able to arrange this for you. 3. the club reserves the right to verify the information provided by candidates. 4. the club reserves the right not to proceed with any application that the committee considers unsuitable. No explanation will be given for the refusal of a candidate.

I hereby apply for membership of the arts club; if elected I agree to be bound by the rules of the club and any Bye-laws made in accordance therewith and to pay such entrance fee and subscriptions as the rules should require. I am over 21 years of age. In accordance with the data Protection act (1998) I authorize my information to be used for internal club purposes only.

s I g N at u r e o f c a N d I dat e

dat e

Please send the completed application form to: the arts cluB 40 dover street maYfaIr loNdoN W1s 4NP

or scaN aNd emaIl to: membership@theartsclub.co.uk

memBershIP NumBer

date elected

P e r s o n a l D e ta i l s
it is most important that we have sufficient information about candidates and their work to make a decision about their application.
Please affix a passport size photograph or email one to membership@theartsclub.co.uk

N at i o N a l i t y

Dat e o f B i r t h

N a M e o f S P o U S e / Pa r t N e r

NaMe of DePeNDeNt/S

h o l i Day o B S e r Va N C e S

P r o f e S S i o N a l Q U a l i f i C at i o N S

B r i e f S U M M a ry o f C a r e e r

P r e S e N t o C C U Pat i o N Please include as much information as you can about recent achievements.

iNtereStS Please make specific mention of connections with the arts, literature and/or science.

ot h e r C lU B S o f w h i C h a M e M B e r

C h a r i t i e S yo U S U P P o r t

C a n D i D at e D e ta i l s

SUrNaMe

title

fore NaMeS

D e C o r at i o N S

hoMe aDDreSS

P o S tC o D e

eMail

telePhoNe

MoBile

B U S i N e S S a D D r e S S (include name of company)

P o S tC o D e

eMail

telePhoNe

ot h e r a D D r e S S

P o S tC o D e

a D D r e S S to w h i C h C o r r e S P o N D e N C e S h o U l D B e S e N t: hoMe BUSiNeSS ot h e r

18 6 3

C R E D I T C A R D AU T H O R I S AT I O N F O R M
TiTle firsT name surname address

Please complete details below to authorise payment:

TyPe of crediT card: american exPress Visa oTher masTercard

name on card card number PosTcode TelePhone fax email sTarT daTe securiTy code i auThorise you To charge my crediT card for: joining fee monThly fee or annual fee exPiry daTe

Please fill in the whole form using a ball point pen and send it to:

THE ARTS CLUb (LOND ON ) LTD 40 D OVER STREET LOND ON W1S4NP

email: accounts@theartsclub.co.uk fax: 020 7409 0913

signaTure daTe

4 0 D O V E R S T R E E T M AY F A I R L O N D O N W 1 S 4 N P

Te lephone 020 7499 8581 Email s e cre tar y@thear tsclub.co.uk

We b thear tsclub.co.uk