Application to become a Full Member of
The Handlebar Club
FULL MEMBERSHIP APPLICATION FORM
 SHADED FIELDS ARE REQUIRED PLEASE 
YOUR NAME IN FULL
YOUR E-MAIL ADDRESS
PREFERRED FIRST NAME
or NICKNAME
ALLOW YOUR NAME & E-MAIL ADDRESS
TO BE SENT TO OTHER MEMBERS?
(LIST ONLY AVAILABLE BY MEMBER'S REQUEST)		 YES PLEASE NO THANK YOU
YOUR ADDRESS - Line 1
YOUR ADDRESS - Line 2
CITY
COUNTY or STATE
POST CODE or ZIP   AGE  
COUNTRY
NATIONALITY
HOME PHONE / MOBILE / CELL
INCLUDE INTERNATIONAL PREFIX IF OUTSIDE THE UK
MOBILE/CELL IF LANDLINE IS ABOVE
OCCUPATION
PROPOSED BY
IF KNOWN BY A CURRENT MEMBER
CLUBS, SPORTS, GAMES
INTERESTS AND OTHER ACTIVITIES
PREFERRED PAYMENT METHOD PayPal CHEQUE
AUTHORISATION CODE Authorisation code Enter code:
Refresh code
Please enter the code exactly as it appears above. The code is CaSe SeNsItIve.

Please note that if you are unable to meet the committee in person, we shall require a recent photograph to prove that you have the required qualification. Please contact Conrad Amis our Secretary, to arrange this.