KLOS New Member Application Form

First name

Last name

Email

Address

Phone

Birthday

Day

Month

Year

If under 16 years of age, please provide parent /guardian contact details:

Parent/Guardian Name

Parent/Guardian Phone

For Health and Safety reasons, please provide details, in the strictest confidence, of any medical conditions which should be brought to the Committee’s attention

Please select which membership type you would like

Please select which subscription you require. Subscriptions are due on 1st August each year (Please Note - Children under 16 only accepted as part of a family membership)

If accepted after audition/interview, I agree to abide by the Rules and Constitution of the Society and to pay the annual subscription when due.

My main interests are – please indicate as appropriate:

My previous experience is as follows:

How did you find out about our Society?

Do you know anyone in the Society? If so, please give their name(s)

Please note: APPROVAL FOR MEMBERSHIP WILL BE AT THE DISCRETION OF THE MANAGEMENT COMMITTEE