Britannia Club orlandogeorgeanddragon

Britannia Club Sign up Page

If you live in the Orlando or Central Florida area then why not join The Britannia Club? Please complete the form below and give us as much information as possible. Please complete one form per Member even if in the same Family Membership is Free! We would like your Date of Birth to enable us to contact you around your Birthday to keep you advised of any Birthday Specials we are offering (if you wish you may leave out the year). We will notify you by E-mail when your Membership Card is ready for collection. Should you have friends that may wish to join please feel free to add thier E-mail addresses in the boxes below and we will contact them.
*Bold fields are required*
*New Members Name*
Male or Female
*Have you ever visited the* *Orlando George & Dragon?*
*Ancestry: Please answer* *as well as you can*
*Country of Birth:*
Born in Country not listed above
*Day of Birth*
*Month of Birth:*
Year of Birth (Not Required , But Don't Worry! we will not tell anyone)
*Address:*
Address (cont):
*City:*
County:
*State / Province:*
*Country:*
*Zip / Postal Code:*
Phone Number:
*Cell Phone Number:*
Fax:
*E-mail:*
*Prefered Password For* *Future Security & Communication*
If You have friends who may like to join type thier E-mail addresses here and we will send them a link to this site:
2nd Friend:
3rd Friend:
4th Friend:
5th Friend:
6th Friend:
*Comments:*	Place Comments in here!

If you have a business and would like to get involved in our business

Networking Please Click on the image to go to Networking Page