Membership Application Form

Please complete all the required fields. When you are satisfied with the application please use the grey submit
button for us to process your application.

Please select the membership type you require

Single
Joint
Family

Please select the membership category you require *

Title

Name *

First

Last

Address Primary member *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Email *

Contact number primary *

Car Registration

Declaration

I/We have read the Clubs Terms and Conditions of membership which are available on the website and agree to abide by them.

Declaration *

Yes

Marketing Prefernces

Yes

I am happy to receive information from the club from time to time

Secondary Member Details

Joint
Family

Please select membership type required

Membership Category

Please select the membership category you require

Title

Secondary members Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Secondary members Email *

Contact Number

Car Registration

Junior /Synergy Memberships Member Details

First Child

First

Last

Date of Birth

Second Child

First

Last

Date of Birth

Third Child

First

Last

Date of Birth

The information that you have provided on this form will only be used for the purpose of your membership at Charterhouse Club. It may be shared with our third party consultants who support this purpose. It will not be used for additional purposes without your consent. All personal data is collected and processed in compliance with General Data Protection Regulations (GDPR) and other data protection laws. Your rights in respect of your data can be found in the Privacy Policy on the Club’s website.

For Office Use Only

Customers Payment Preference