Keyworth and District Probus Club 
Expression of Interest in Joining Probus. 
Please complete the form below and return to: the 
Secretary
49 Selby Lane
NG12 5AQ
First Name 
Family Name 
Address 
Post code 
Landline and mobile numbers 
Email address 
Career details/qualifications 
Partner's name 
Applicant's signature 
If you wish make an enquiry by email please use the following address: 
enquiry@keyworthprobus.org.uk 
| The information you have provided on this form will be used by the club for the purposes only in connection with the running of the club, which includes communicating by post, telephone and email. It will never be disclosed for marketing purposes.The committee produces a directory of members, available only to the members, in which this information will be published. |