Welcome to the Clermont Club

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Were you an existing member of the Clermont Club? *

Yes

No

Please tick the box if you do not want to receive marketing communication such as promotions and events.

No Marketing Please

Interests

Please select all/any interests from the following:

Cigars

Fashion

Musicals

DJs

Country Pursuits

Sport

Theatre

Literature

Beauty

Wine & Spirits

Travel

Politics

Comedy

Film

Family Entertainment

Music

Dance

Technology

Food

Art & Design

Yoga

Wellness

Declarations *

Please tick ALL below declariuon boxes to proceed with your application

I am over 18 years of age and hereby apply to join Clermont Club. In order to become a member, I understand that I must provide government issued photo identifi cation and that a photograph will be taken of me, which will be kept by the Clermont Club.

I confi rm that I am not currently enrolled in any National Self-Exclusion scheme such as SENSE and Gamstop.

I confi rm that I have read, understood & agree with the membership terms and conditions and that I will abide by them.

Date *

MM

DD

YYYY