I declare that I understand the Constitution of "The Old Fossils" Gentlemen's Club and that I will abide by the rules of the said Constitution.

_____________________________________PERSONAL DETAILS __________________________________

Mr _______________________ Initials ________ Surname ________________________________________

Address _____________________________________________________________________________________

____________________________________________________________________________________________

Town _________________ Postcode ___________ Tel. No. _________________ E-Mail _________________

_______________________________________ PROPOSAL _________________________________________

To become a Member of the Club you have to be Proposed and Seconded by two existing members.

Proposed by ___________________________________

Print Name ___________________________________

Seconded by ___________________________________

Print Name ___________________________________

________________________________ DATA PROTECTION ACT _________________________________

Under the 1998 Data Protection Act ( N.B. No information of your personal data will be passed on to any other company or agency for private or commercial purposes. )

Signed _________________________________________ Date _____________________________________

As a member you will eligible to purchase and wear a membership badge.