Spouse Membership Registration Form

Please fill in details of the individual in whose name the membership is held. This will often be the male head of household. (*) = required field
Members First Name (*)*
Members Middle Name
Members Surname (*)*
Members Date of Birth
MM slash DD slash YYYY
Members Email Address*
Members Mobile*
Members membership number ( if Known)
Please fill in your address details below*
Street Address City ZIP / Postal Code Country
Spouse First Name (*)*
Spouse Middle Name
Spouse Surname (*)*
Spouse Date of Birth*
MM slash DD slash YYYY
Spouse Email Address
Spouse Mobile
Please fill in your address details below*
Street Address City ZIP / Postal Code Country
The information on this form will be retained by The KSIMC of London for its use and may be shared amongst its sub-committees and parent organisations (CoEJ, WF) as and when necessary and requested.
Consent
We may also use the information to inform you of events/projects that we or our affiliates feel may be of interest to you. If you consent to this, please check the box below.