Upstairs Membership Application

Declaration:

I hereby apply for membership of Upstairs at Langan’s. I agree to abide by the Club Rules (to be found at www.langansbrasserie.com) and pay any bills incurred by me and my guests.

By submitting this form I consent to my data being stored for the purposes laid out in the Langan’s Brasserie privacy policy including the administration of my membership, reservations, billing and other administrative matters.

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Title *

First Name *

Last Name *

D.O.B *

Nationality *

Email *

Contact No. *

Anniversary

Home Address Line 1 *

Home Address Line 2

City / Town *

County

Postcode *

Country *

Business Address Line 1

Business Address Line 2

City / Town

County

Postcode

Country

Members who can propose you *

Other memberships you hold *

Reason for wanting to join *

Profession *

Company *

Instagram

Do you agree to provide a headshot of yourself for ID verification purposes via email to upstairs@langansbrasserie.com after submitting this form? This is mandatory and will help us ensure safety and security for all members. * Yes, I agree to provide my headshot via email *

By completing the fields above you give us permission to correspond with your assistant regarding bookings, bills and any other matters relating to your membership Assistant's Name

Assistant's Email

Please tick this box to agree to receive our marketing communications, news and invitations.

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