To Print The Application form:-

In Google Chrome or Microsoft Edge -- Hold left mouse Button and highlight the Application form, then in the blue highlighted area Press Right Button then left click 'PRINT"   

Note. Two (2) sponsers not reqired on application.

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THE PROBUS CLUB OF CARLINGFORD

Probus Club Membership Application Form

I hereby apply for membership of the Probus Club of Carlingford

Title:………………………..…...Surname: …………………………….…………………………..…………….………………..… 

Given Names:…………………………..….…...……………………………..……………………….…………….

Preferred Name on Badge: ………………….………………………………………………..…………………..…………………

Spouse/PartnerName: ……………………………….…...….…………………………………….

Address: ………………….………………….………………….…………………………..…….…………………………………..…

……………………………….………………….………………………………………………………………………..…………….…

Email Address: ………………….…………………………….………………………………………………..……………………..

Postcode: ……………………………Telephone: ………………….………………

mobile:………………….………………………………………………………….……

Former Vocation:………………….………………….…………………………………………………………………………………

Hobbies,Sporting & Other Interests: ………………….……………………………………………………………………………

………………………….………………….…………………………………….. ………………………. ………………….................

Incase of emergency, please contact:………………….………………….…………………………………………………………………………………………….

………………….…………….....................................................................................................................................................

Emergency Contact Telephone: …………………. ……………..

1. I agree to be bound by the provisions of club's constitution, by-laws and/or standing resolutions and agree

to take an active role in the Club through my attendance and participation.

2. I understand that the information providedin this application will beused to assess my application

3. I understand that my application may not be processed if any of the above information is not provided.

4. I acknowledge that at some time during my membership, I may be called upon to take an active role on the Management Committee.

5. I consent to my name, address, telephone number and email address being included in the Directory of Members to be distributed only to members of the Club.

6. I understand that I may access any personal information the Club holds about me upon request.

7. I accept that the information provided in this application form will be provided to Probus South Pacific Limited (PSPL) in accordance with the PSPL Privacy Policy which can be viewed on the PSPLwebsite

8. I understand that the minimum information required by PSPL is my first name and last name and that it is my responsibility to advise the ClubSecretary in writing if I do not want  PSPL to hold anyof the additional information in this application form or I do not wish to becontacted by PSPL.

9. I understand that the Club has Public Liability Insuranceof $20 million through PSPL and that I can access a summary of this coverage through the Club Secretaryor the PSPLwebsite.

10. I understand that the Club may publish photographs of its members on its website, in its newsletter and/or on social media to promote the Club and its events.By signing this application form, I consent to the publication of such photographs unless I have advised the ClubSecretary in writing that I do not consent to such publication.

11. I understand that the Club Secretary may provide photographs of its members for use in PSPL's publications,website and/or social media. Bysigning this application form, I consent to the publication of such photographs unless I have advised the ClubSecretary in writing that I do not consent to such publication.

12. I agree to receive the Active Retirees E-newsletter published by PSPL and understand that I can unsubscribe from the E-newsletter at any time.

Applicant’s Signature: ………………….………………….

Sponsored by:………………….……………………………… Signature:…………………. ………………… .Date: ………………….….…   

Sponsored by: ………………. ……………………………… Signature: ………………….………….. ……. Date: ……………………..…

MEMBERSHIP APPLICATIONS MUST BE SPONSORED BY TWO FINANCIAL MEMBERS OF THE CLUB CLUB USE ONLY

Date Received: …….…………… Committee Approval on………………… Subscription Received:…….……………

Membership badge ordered ………........   

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