Membership Application Form

Please fill in the following application form to confirm your interest in applying for membership at The Northern.  Telephone 0161 445 3093 to arrange for a tour of the facilities, and/or to complete your membership application process.

Personal Details

Title*	Please select...MrMrsMissMsDrOther
First Name*
Surname*
Gender*	Male: Female:
Address Line 1*
Address Line 2
Address Line 3
Postcode*
Email
Phone*
Mobile
Date of birth	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Occupation
Business / Educational Establishment Name
Business / Educational Establishment Address
Postcode
Phone

Next of Kin

Name*
Address
Postcode*
Phone*
Relationship

Membership type

Please select whether you would like to sign up as an individual or as a group of two or more.*

Individual

Joint

Option

Please select... Adult Fitness and health Student (Under 30) Off Peak Country Junior (Under 19) Junior (Under 11) Aerobics Aerobics (Non Financial) Hockey Martial Arts Dance Social Other

Option

Please select... Adult Fitness Junior Under 19 Junior Under 11 Mature

Linked to Name
Linked to Membership no.

Club Interests

Tennis
Squash
Gym
Fitness
Social
Other
If other, please specify:

Interest in the Club

How did you hear about the club?

Please select...Yellow PagesAt your work placeLeaflet through doorNewspaper / MagazineRecommended by MemberSignage / BannerWebsitePoster

Corporate discounts available on request.