Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of birth (members must be 16 or over) *

MM

DD

YYYY

I confirm I am resident in the UK for tax purposes *

Yes

No

Payment method you will use

BANK TRANSFER TO Business account name: Minehead Swimming and Leisure Limited ~ Bank: The Co-operative Bank ~ Account number: 67367676 ~ Sort Code: 08-92-99 ~ Ref: [your surname your postcode]

CHEQUE PAYABLE TO "Minehead Swimming and Leisure Limited". After you submit this application, you will receive an email with the postal address to send your cheque.

I understand that the share(s) bought through this application do NOT form part of any share offer, and do not earn interest, and that by joining I am becoming a class 2 member as set out in the rules of the Society. I understand that the issuing, transfer and withdrawal of shares are laid out in the rules of the Society which can be found here (see Registration of New Society document): https://mutuals.fca.org.uk/Search/Society/30765 *

Yes

No

I have read and consent to the above privacy notice *

Yes

No