MEMBERSHIP APPLICATION FORM

 

Name                __________________________________________________

 

Address            __________________________________________________

 

                        __________________________________________________

 

Postcode                                       

 

Home Tel                                               Work Tel                                  Mobile   _________________

           

Email Address  ________________________________________________ Age      _________________

 

 

Please indicate where you heard about L.I.N.

 

Newspaper.  Which publication?  ______________________________________________

 

Internet                                    ______________________________________________

                        

Recommendation                       ______________________________________________

 

Other                                        ______________________________________________

 

Individual membership joining fee: £50 / Two people sharing the same address joining fee: £70

 

Make cheques payable to London Irish Network and send to:

 

London Irish Network, 77 Beak Street, Box 103, London, W1F 9DP. ATTN: Membership Secretary

 

Signature          ___________________________             Date:    ____/____/____

 

Which sort of events would you particularly be interested in attending?  Please click in the box(es) below.

 

Cultural             q      Theatre/Cinema             q

Sports               q      Holiday Breaks              q

Walks               q      Bars/Pubs                     q

Restaurants       q      Other                            ____________________

 

Please tick this box if you would be interested in hosting events.               q

Any information you submit is COMPLETELY confidential and will not be given out to any other parties except with your permission.