Standing Order form

Once you have completed the form below you can pay using this standing order form: [STANDING ORDER]

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Membership Application Form
Name
First Last
Date of Birth*
DD slash MM slash YYYY
Title*
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Home Phone Number
Mobile Phone Number
Email*
Type of season ticket*
- Adult: £25
- Joint: £38
- Senior (65+):£19
- (16-18): £19
Couples membership requires you to live at the same address and payment must be from one bank account. Please fill out a form each and submit both ticking the relevant membership type box.
Name (Second)
First Last
Title*
Date of Birth*
DD slash MM slash YYYY
Email*
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Declaration: Please sign to confirm that all details are correct and that you have read and understood the terms and conditions overleaf. Data Protection: The Moretonhampstead Sports & Community Centre will use your personal data solely for the purpose of processing and maintaining your Gym membership. Your data will not be shared with any third party and the principles of the Data Protection Act 1988 will be adhered to. MSACC will use your personal data only for the purpose of your use of the Gym and Classes run by MSACC.
Consent
I agree.
Please tick this box to confirm that you are happy to receive information from MSACC about your membership, the facilities and activities including special offers by post, email or phone.
Applicants Signature
Second Signature (Joint):
HAVE YOU BEEN A MEMBER OR HAD AN INDUCTON WITH US WITHIN THE PAST 2 YEARS*
- Yes
- No
Please take a few moments to answer the following questions as this will help us improve the activities and services that we provide.
How did you hear about MSACC Ltd?:
What activities are you most interested in?:
What services/activities would you like us to provide?
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Standing Order form

Join up here

Membership Application Form