Please print off and complete the form below and email it back to Lucy@kitchensocialcookeryclub.co.uk with the attachments.  Please type the following in the subject line "NEW MEMBER (YOUR SURNAME) AND TODAYS DATE" or bring the completed form with you and copies of the proof required along with your registration fee to the shop on any Tuesday to Friday from 12noon to 6pm (term time)

YOUR FULL NAME:

 

 

YOUR DATE OF BIRTH

          /          /

HOUSEHOLD FAMILY MEMBERS AND THEIR AGES

NAME'S & AGES

Example:

(Household of 4, x 1 Adult and x 3 Children

 (Samantha 7yrs, Kye 2yrs, Paula 3 months))

 

 

 

 

 

 

 

YOUR FULL ADDRESS WITH POSTCODE:

 

 

 

 

POST CODE:

YOUR TELEPHONE NUMBER:

 

 

YOUR EMAIL ADDRESS:

 

PLEASE ATTACH THE FOLLOWING:

Proof of address e.g., Council tax bill, Licence, Electricity bill etc.

and

Proof of income if claiming benefits:

e.g., Award letter, Universal Credit, Payslip

ATTACHED         Yes      or        No

 

Any dietary requirements for you or your family?

IF YES, PLEASE SPECIFY:

Yes                        No

 

 

EMERGENCY CONTACT Name:

Telephone Number:                                                    

Relationship to You:

 

Do you need us to make any reasonable adjustments regarding your access to the premises, IF YES PLEASE SPECIFY:

Yes

No

Please Transfer the Membership Fee to the following account: Name: Kitchen Social and Cookery Club

Account Number: 00275651       Sort Code: 23-11-85

REF: MEM/ (Your Surname)

 

Once transferred, please email Lucy@kitchensocialcookeryclub.co.uk

To notify us you have paid, we can then confirm and prepare your membership for when you arrive and attached your I/D (a photograph of this should be fine)

 

Please provide us with your consent to allow us to use your personal data within our group or to contact you with special offers, take photographs, short videos as we may like to use these for marketing purposes to help promote Kitchen Social & Cookery Club. 

Yes

YOUR SIGNATURE:

 

PLEASE DATE: