New Member Form

First Name *

Preferred Name

Last Name *

Gender

Date of Birth

Marital Status

Anniversary

Home Address

Home Address Line 2

Home City

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Mailing Address

Mailing Address Line 2

Phone Number

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Email Address

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I agree to have my detailed included on the member directory:

I would like to subscribe to the weekly St Bart's Snippets email:

I give permission for St Bart’s to take photographs or video footage of me and members of my family whilst involved in activities of St Bart’s. I authorise St Bart’s to use and publish the images to highlight St Bart’s. I have read and understood the statement of release.

I give permission for St Bart's to take photographs or video footage of me and members of my family whilst involved in activities of St Bart's (conditions detailed above):