The Social Room Member Application Form
The Social | 527 Park Street | www.thesocialroom.net

MEMBERSHIP APPLICATION

To protect all applications and members, absolutely none of the information provided below will be released or sold to any outside entity.

* indicates a required field
Date:
MEMBERSHIP LEVEL REQUESTED: * SINGLE DUAL CORPORATE
  ($29.00 /mo.) ($39.00 /mo.) ($1200.00 /yearly)
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First Name:* Last Name:*
Address:* City:
Zip code :*    
E-Mail:* Mobile #*
Twitter: Facebook
Company Name: Dual Member:
if any   if any  
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MEMBER THAT REFERRED YOU:
First Name:* Last Name:*
FRIENDS THAT YOU WOULD LIKE US TO CONTACT FOR POSSIBLE MEMBERSHIP:
First Name: First Name
Last Name Last Name
E-Mail E-mail
Cell Phone Cell Phone
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MEMBER AGREEMENT TO KEEP CREDIT CARD ON FILE:
I agree to keep my credit card on file and authorize The Social to use my card to handle any outstanding charges, including % gratuity:
At all times, or
Only when I leave without closing my tab.
CREDIT CARD INFORMATION:*
VISA    MASTERCARD     AMERICAN EXPRESS    
Card #* Exp:* CID Code: *
 
MEMBER ACKNOWLEDGEMENT & AGREEMENT OF POLICIES:

I, , am hereby applying to become a member of The Social for a month to month basis following the date of this application. I have read the Social membership policies provided online at www.thesocialroom.net, or at the Social. As evidenced by my signature below, I agree to comply with all such policies.
*For corporate accounts, credit card will be charged full amount upfront annually.
* * *
Sign - (Enter name again) DOB Today's Date

By providing your DOB (Date of Birth) you are temporarily signing this online form. When approved, you will be obligated to sign a hard copy of the Primary Member Information upon first visit to The Social Room.

Corporate Memberships?

$1200 Annually


  • Four membership cards for individuals or your company.
  • Cards may be shared with associates or customers.
  • Includes entry for members plus 3 guests at no charge, during all membership hours.
  • No rental fees for hosting parties.
Great Networking Opportunities!