Become a Member of Pontefract Conservative Club

1. Are you a member of any other Social, Political, Sports, Association or Working Men’s Club?

YES NO

2. Have you ever been refused membership of any club or association?

YES NO

3. Have you ever been excluded or suspended from any club or association?

YES NO

4. Have you ever been convicted of a criminial offence or have you any criminial proceedings pending?

YES NO

In applying for membership please state breifly your reasons for becoming a member of The Pontefract Conservative Club:

I accept that this application is to join a Private Members Political Club, which supports and promotes the principles of the Conservative Party. In addition I confirm that the information, which I have given above, is correct, and I hereby agree to abide by the Rules and Regulations of The Pontefract Conservative Club.

BY CLICKING THIS BOX YOU AGREE TO THE ABOVE TERMS

APPLICANT

Date

PROPOSER

SECONDER

SURNAME
FORENAMES
MARRIED SINGLE DATE OF BIRTH
SPOUSE
OCCUPATION

ADDRESS
POSTCODE
TELEPHONE
EMAIL