Online Application - The Fort Worth Club

Member Application

(*) denotes required field.

OPTIONAL ADD-ONS:

Wine Society - Couple
Wine Society - Individual
Beer Club - Couple
Beer Club - Individual

I. APPLICANT INFORMATION

PREFIX:*

FIRST NAME:*

MAIDEN NAME:

LAST NAME:*

HOW WOULD YOU PREFER YOUR NAME BE RECORDED?:*

GENDER:*

Male
Female

DATE OF BIRTH:*

UPLOAD A HEADSHOT:

HOME ADDRESS:*

CITY:*

STATE:*

COUNTY:*

ZIP CODE:*

CELL PHONE NUMBER:*

PERSONAL EMAIL:*

WORK EMAIL:*

BUSINESS NAME:*

TITLE:*

INDUSTRY:*

(ex. Oil and Gas, Healthcare, Banking etc.)

BUSINESS PHONE NUMBER:

BUSINESS ADDRESS:

CITY:

STATE:

ZIP CODE:

HOW LONG HAVE YOU BEEN WITH YOUR PRESENT BUSINESS?:

UNIVERSITY:

DEGREE:

YEAR:

UNIVERSITY:

DEGREE:

YEAR:

CONTACT INFORMATION LISTED ON STATEMENT:*

Personal
Business

EMAIL ADDRESS TO RECEIVE STATEMENTS:*

I REQUEST A SEPARATE PERSONAL EXPENSE PROFILE:*

Yes
No

WHAT WAS THE MOST INFLUENTIAL FACTOR IN YOUR DECISION TO JOIN THE CLUB?:*

HAVE YOU EVER BEEN DENIED MEMBERSHIP OR EXPELLED FROM ANY CLUB:*

Yes
No

IN THE PAST TEN YEARS HAVE YOU OR YOUR SPOUSE EVER BEEN CONVICTED OF ANY CRIMES (EXCLUDING MISDEMEANORS AND SIMILAR OFFENSES) THAT HAVE NOT BEEN EXPUNGED FROM YOUR RECORD OR SEALED BY THE COURT?:*

Yes
No

IF YES, DESCRIBE IN FULL:

II. SPOUSE INFORMATION

SPOUSE/SIGNIFICANT OTHER PREFIX:

FIRST NAME:

MAIDEN NAME:

LAST NAME:

DATE OF BIRTH:

GENDER:

Male
Female

CELL PHONE:

EMAIL:

UPLOAD A HEADSHOT:*

BUSINESS NAME:

TITLE:

INDUSTRY:

(ex. Oil and Gas, Healthcare, Banking etc.)

BUSINESS PHONE NUMBER:

BUSINESS ADDRESS :

CITY:

STATE:

COUNTY:

ZIP CODE:

UNIVERSITY:

DEGREE:

YEAR:

UNIVERSITY:

DEGREE:

YEAR:

III. CHILDREN/DEPENDANT INFORMATION (Only children age 26 and under are considered dependents)

FULL NAME:

DATE OF BIRTH:

GENDER:

Male
Female

FULL NAME:

DATE OF BIRTH:

GENDER:

Male
Female

FULL NAME:

DATE OF BIRTH:

GENDER:

Male
Female

IV. COMMUNITY & CLUB AFFILIATIONS

LIST ALL CLUBS, SOCIETIES, AND ASSOCIATIONS IN WHICH YOU HOLD MEMBERSHIP. IF NONE, PLEASE STATE:*

IF YOU ARE RELATED TO A MEMBER, PLEASE LIST NAME HERE:

LIST THE TWO MEMBERS WHO ARE PROPOSING YOU FOR MEMBERSHIP.

PRIMARY SPONSOR:*

SECONDARY SPONSOR:*

By signing this Application, Applicant warrants and represents that the information set out in this Application is true and correct in all respects. Applicant agrees that if elected to membership, Applicant will abide by The Fort Worth Club By-Laws and its Rules and Regulations that are either now in effect or as hereafter modified or adopted. Applicant further understands and agrees that if Applicant is elected to membership in The Fort Worth Club, any false statements or omissions of facts on this Application will be considered sufficient cause for dismissal. With regard to any background check undertaken by The Fort Worth Club to inquire about Applicant’s character, general reputation, personal characteristics, mode of living, credit, etc., Applicant understands that the information given by Applicant in this Application is to be used solely in determining Applicant’s eligibility for membership and that it will be adequately safeguarded and will not be released by The Fort Worth Club without Applicant’s prior consent. By signing this Application, Applicant specifically authorizes The Fort Worth Club to investigate Applicant’s personal history, financial and credit records, and criminal records through any investigative criminal, credit agencies, or bureaus of The Fort Worth Club chooses. Applicant agrees that such information may be used in connection with any determination regarding Applicant’s eligibility for membership.

If elected to membership, Applicant agrees that any photos taken on Club Property of Applicant, associated dependents, or guests may be used for marketing and promotional materials for the Fort Worth Club members. All Members are required to attend a New Member Orientation within 90 days of acceptance for membership. Further Applicant understands that upon approval of the application, membership status remains provisional for one year following such approval, during which Applicant:

is not eligible to vote as a member of the Club on any matter brought before the membership for a vote;
may not serve on any committee of the Club; and
remains subject to termination for any behavior unbecoming of a Member, as determined by the Executive Commitee, in its sole and unfettered discretion, effective immediately without the right to appeal such decision, request a hearing on such decision, or otherwise exercise any other rights of due process.

Membership status is granted to Applicant as an individual and is not represented or owned by any business or employer, except for specified corporate memberships. Payment of all dues and charges are the sole responsibility of Applicant, except for specified corporate memberships. Statements are issued around the first business day of the month and payments are due by the 15th of the month. A finance charge is imposed on all past due balances. Applicant understands that a 30-day written notice is required to resign the membership. Resignation notices must be provided by Applicant directly to the Membership Department. Membership resignations are effective on the last day of the month following satisfaction of the 30-day waiting period.

Application Agreement & Release of Liability

I HAVE READ AND CONSENT TO THE APPLICATION AGREEMENT AND RELEASE OF LIABILITY FOR ALL PRIMARY, SPOUSE, & DEPENDENTS:

APPLICANT SIGNATURE:*

(Please type name)

DATE:*

Applications will not be approved until initiation fee is received and the membership committee approves

Membership Application

Member Application

I. APPLICANT INFORMATION

II. SPOUSE INFORMATION

III. CHILDREN/DEPENDANT INFORMATION (Only children age 26 and under are considered dependents)

IV. COMMUNITY & CLUB AFFILIATIONS

LIST THE TWO MEMBERS WHO ARE PROPOSING YOU FOR MEMBERSHIP.