directdebitform

APPLICATION FOR MEMBERSHIP By Direct Debit

Please select your membership of choice Direct Debit

Club Membership £7 per month

Joint Club Membership £8.50 per month

Applicant 1

Title

Forenames

Surname

Telephone

Mobile

E-mail *

Job Title

Company

___________

________________________________

Applicant 2

Title

Forenames

Surname

Telephone

Mobile

Job Title

Company

___________

_________________________________

____________

_________________________________

For joint memberships both members must live at the same address:

Address:

_________________________________________________________________________________________

Town _______________________________________ County _______________________________________

Post Code: ______________

Members Birthday: __________________ Partners Birthday: ______________________ Anniversary: _________________

* Providing Design Restaurants with your e-mail address will allow us to send you updates on new restaurants, validity times and offers. If you do not wish to receive these offers please omit your email address.

We invite you to advise us of any friends or family who you feel may be interested in receiving details of Design Restaurants.

Name: ____________________________________________ Contact Number: _______________________________________________

Please send in a sealed envelope to the registered office address below allowing 7 days for delivery of your membership package.

Thank you for your application, we look forward to welcoming you to Design Restaurants.