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Membership Application

Applicant’s Details

Title (e.g. Mr, Mrs, Miss or rank)

Surname

Forename

Date of birth

Decorations or qualifications (e.g. OBE, FRAgS, BSc)

Private address

Postcode

Mobile number

Alternate telephone number

E-mail address

Business / Employer Name

Postcode

Mobile number

Billing Email Address (If different)

Current occupation/profession (e.g. farmer, landowner, banker, adviser, supply trade)

Type of Membership Applied For

Please tick ONE box from below

Farmer / Landowner / Manager

Ancillary Business / Countryside

Associate (i.e. Forty Club, Whitehall Court)

Please tick ONE box from below

Individual (age 35 +)

Individual (under 35)

Family (entitles spouse/partner and children under 18 to independent use of Club.)

If Family Membership is applied for, please complete

Spouse/Partner

Date of birth

Mobile number

Child 1

Date of birth

Child 2

Date of birth

Agricultural, Food and Farming or Countryside Connections

Please use this space to provide up to 100 words detailing your main farming and countryside activities or connections – for example: acreage owned, farmed or managed; role in agribusiness; cropping; livestock kept; food products supplied; qualifications; posts held; and membership of other professional organisations, clubs or societies.

Formal Statement

I wish to become a Member of The Farmers Club. I agree to pay my entrance fee and initial subscription due by direct debit at the beginning of the month following my election. Subsequent annual subscriptions will be collected by direct debit in January. I agree to obey the rules of the Club, be guided by the Committee, promote the welfare of the Club and assist it in furthering its objectives.

Please include a passport style photograph for your Club record and to assist the staff team. Please ensure Sponsors section and Direct Debit mandate below are also complete before returning form.

Signature

Date:

Sponsors

To apply for membership you must be sponsored by two current Members of the Club. Please give the names, email addresses and daytime telephone number of your sponsors, state how long they have known you and ask them to sign the form. The proposer should also provide a statement supporting the application, outlining the contribution the applicant can make to the life of the club. In signing this form the sponsors confirm both that they recommend the applicant to the Club and the applicant’s involvement in farming or commitment to the farmed environment.

Name of proposer

Daytime tel. no(s).

Years applicant known to sponsor

Signature

Supporting statement

Name of seconder

Daytime tel. no(s).

Years applicant known to sponsor

Signature

You can set up a Direct Debit to pay for your memberships annually, please follow the link below to download and print our Direct Debit Mandate Form.

Direct Debit Mandate Form

Submit

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