Join Online

To join online please complete the form below

Full Name*
First Name Last Name

I Live at*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone Number*
- Area Code Phone Number
Mobile Phone Number
- Area Code Phone Number
E-mail Address*
Marital Status*
Your Gender*

Male Female
Birth Date*
Day Month Year
Transportation

I have a car I have access to other transport
How did you find out about us?
If through a member, who ?
Membership Type*

Annual Subscription (£127.20) Half-Yearly Subscription (£89.67) Annual Email Subscription (£108.50) Half-Yearly Email Subscription (£72.20) New Year Special Offer – 3 months email membership (£30.00) New Year Special Offer – 3 months postal membership (£30.00)

By selecting one of our email subscriptions you are accepting to receive the Nexus monthly bulletin and Ice-Breakers by email.

By submitting this form I am stating that the information above is true.

I undertake to hold all information supplied by Nexus in complete confidence at all times.

I affirm that the function of Nexus is the provision of information given to it by its members to facilitate communication.

I clearly understand that Nexus is not a marriage bureau or introduction service and that it offers members the means to create a better life by meeting both socially and / or individually and that it is not responsible for any occurrence as a consequence of any meeting with, or relationship formed as a result of membership.

I apply to be accepted for membership on this basis.

Should be Empty: