APPLICANT INFORMATION

_____Mr. _____Mrs. _____Miss _____Ms. _____Dr. _____Other

First Name_________________________      Last Name_________________________

Date of Birth (Primary Applicant must be at least 21 years old)_________________________

Primary Address _____________________________________________________________________

City:______________________________St:________Zip:_____________

Home Phone_(______)__________________      Mobile Phone_(______)__________________

Fax Number_(______)__________________      E-Mail_______________________________________

_____Single Membership(1 person)      _____Couple's Membership (2 adults)

(Skip this section if you are applying for a Single Membership)

Spouse’s First Name_________________________      Spouse’s Last Name_________________________

All information contained in my Prohibition Club Membership Application and all other information, if any, that I have provided to The Prohibition Club is complete and correct.

Signature of Applicant______________________________      Date_________________________

Signature of Spouse_______________________________      Date_________________________

Single Membership Applicant

Print Applicant Name________________________________________________

MEMBERSHIP FEES PER YEAR ARE AS FOLLOWS:
SINGLE MEMBERSHIP FEE per year is $175.00 plus 7% tax.
COUPLE MEMBERSHIP FEE per year is $275.00 plus 7% tax.
(ALL PRICES SUBJECT TO CHANGE WITHOUT NOTICE)

ONE TIME INITIATION FEES ARE AS FOLLOWS:
ONE TIME SETUP FEE OF $10.00 PER PERSON plus 7% tax, MUST BE PAID IN FULL ON ACCEPTANCE OF APPLICATION.
(ALL PRICES SUBJECT TO CHANGE WITHOUT NOTICE)

Signature of Applicant______________________________      Date_________________________

RULES AND REGULATIONS
Membership will be acquired solely for social and recreational purposes in accordance with the Rules and Regulations of The Prohibition Club.

No voting rights nor any other rights to establish, alter, amend or abolish rules, regulations or general Prohibition Club policy accompany Membership in The Prohibition Club.

The Prohibition Club Members do not have any right, title or interest what-so-ever in or to The Prohibition Club facilities, The Prohibition Club assets and do not hold any ownership interest in The Prohibition Club.

The Prohibition Club Membership is strictly at will and may be terminated at any time, with or without cause, by either the Member or The Prohibition Club. The initiation and Membership fees are non-refundable!

I agree to abide by The Prohibition Club Regulations and any rules that may be promulgated by The Prohibition Club from time to time, and to be responsible for the conduct of my family and my guests.

By signing below, I (We) have read, understand, and agree with all content located on www.prohibitionclub.com.

Signature of Applicant______________________________     Date_________________________

Signature of Spouse_______________________________      Date_________________________

Copy of Photo ID For identification purposes, the application must include a clear color copy of a photo ID of each applicant.

IT IS OUR PLEASURE TO OFFER OUR MEMBERS THE VIBRANCY OF THE PROHIBITION CLUB, ALONG WITH THE HISTORIC 1922 GRAYL’S HOTEL.

SINCERELY,
DALE AND MARY GRAYL

FOR OFFICIAL CLUB USE ONLY:

This Application for Membership shall not be binding upon The Prohibition Club until the acceptance below is signed by a representative of the Prohibition Club Board of Directors.

APPROVED AND ACCEPTED: THE PROHIBITION CLUB BY:

Representative’s Signature ___________________________________     Date_______________

____________________________________________________________ Representative’s Printed Name