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Thursday, 14 February 2013

Application Form for Brighton Arts Club



Membership Application

Applicant Information BRIGHTON ARTS CLUB


Financial information is optional and only necessary for running your bar tab or giving purchase credit
Name:
Date of birth:
NI:
Phone:
Current address:
City:
State:
ZIP Code:
Own         Rent        (Please circle)
Monthly payment or rent:
How long?

Employment Information

Current employer:
Employer address:
How long?
Phone:
E-mail:
Fax:
City:
State:
ZIP Code:
Position:
Hourly     Salary      (Please circle)
Annual income:

Emergency Contact

Name of a relative not residing with you:
Address:
Phone:
City:
State:
ZIP Code:
Relationship:

Spouse Information if joint membership

Name:
Date of birth:
NI:
Phone:

Spouse Employment Information

Current employer:
Employer address:
How long?
Phone:
E-mail:
Fax:
City:
State:
ZIP Code:
Position:
Hourly     Salary      (Please circle)
Annual income:

References

Name
Address
Phone






Children if membership privileges desired

Name
Name
Name
Name

Signatures

I authorize the verification of the information provided on this form as to my credit and employment. I have received a copy of this application.
Signature of applicant:
Date:
Signature of spouse (only if for a joint membership):
Date:




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