ULYSSES CLUB GREAT BRITAIN: Membership Application Form Ulysses Membership Form Date of application Please select the membership you wish to apply for: * Individual annual membership joint annual membership Individual member End Section Personal details Title MrMrsMsDrProfRevOther Title Surname First Name Date of birth Nickname/Username This is essential for entry to the member's area of the website End Section Contact Details Address line 1 Address Line 2 Town/City County Postcode Email Address This is essential for entry to the member's area of the website Telephone Mobile End Section Family member at same address End Section Personal details Title MrMrsMsDrProfRevOther Title Surname First Name Date of birth Nickname/Username This is essential for entry to the member's area of the website End Section Contact Details Email Address This is essential for entry to the member's area of the website Telephone Mobile End Section How did you hear about us The information supplied on this form will be held on the club database. Your details may be passed to other club members. Your details will not be sent outside of the club. If you do not wish your contact details to be passed to other members, please place a tick in the box: I do not wish my membership details to be passed on to other members Payment Please select payment method * Cheque Bank transfer Please send a Cheque/Postal Order payable to “Ulysses Club GB” and crossed Account Payee Only for the total membership fee due to The SecretaryUlysses Club GB1 Tearsall ViewWensleyDerbyshireDE4 2LJ The Secretary will e-mail you bank account details once your application is received Please note that your membership will not be approved until full payment is received End Section I hereby apply for Membership of Ulysses Club GB. I undertake not to use the Club, its name or any of its facilities, for any trade, advertising or business purpose, or in connection with any legal proceedings, or for the purpose of personal business gain.
