MEMBERSHIP APPLICATION FORM

Please provide us with some information about yourself and complete the following direct debit form. Your application will be submitted and we will contact you within two working days.

Please use the postal address corresponding to your credit / debit card that will be used for your direct debit. All other contact details are exclusively for us to be able to contact you.

TITLE
FIRST NAME
SURNAME
DATE OF BIRTH
EMAIL ADDRESS
CONFIRM EMAIL ADDRESS
HOUSE NAME/NUMBER
COUNTY
STREET NAME
TOWN/CITY
POSTCODE
TELEPHONE
MOBILE
Which of our Crazy Bear venues have you visited?

STADHAMPTON

BEACONSFIELD

FITZROVIA

COVENT GARDEN

FARM SHOP

NONE
How did you hear about The Crazy Bear Members’ Club?
Please tell us why you would like to be a member?
Are you a member of any other members’ clubs? If yes, which?
Are you a member of any lifestyle or concierge services? If yes, which?
The Crazy Bear Members' Club
E: [email protected]
T: 0207 5205451