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Membership Application

Title

Step 1 of 4

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Member Applicant Information
Member Name*
First Last
Member Date of Birth*
Month
Day
Year
Member Address
Street Address City State ZIP Code
Member Phone*
Member Personal Email*
Member Place of Work
Member Work Address
Street Address City State ZIP Code
Member Work Position/TItle
Secretary/Assistant Name
First Last
Work Phone
Work Email

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Personal References (list two)
Member of the 1818 Club (If applicable)
1818 Club Member Reference Email (If applicable)
Other Reference (If applicable)
Other Reference Email (If applicable)
List other clubs, societies, and professional affiliations

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Family Information
Spouse Name
First Last
Spouse Date of Birth
Month
Day
Year
Spouse Place of Work
Spouse Work Address
Street Address Address Line 2 City State ZIP Code
Spouse Work Phone
Spouse Work Email
Spouse Personal Email
Wedding Anniversary
Month
Day
Year
Children’s Name and Date of Birth

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Membership Ownership
Please direct my monthly statements to my:*
- Home Address
- Business Address
My membership will be:*
- Owned by me individually
- Administered through my company, I am the approved designated member
Please direct email notices about Club events to my (check all that apply):*
- Personal Email
- Business Email
- Spouse Email
- Opt out of Emails
I am applying as:*
- Individual
- Corporate Sponsorship
- Young Executive
- Corporate Umbrella (MINIMUM OF 6 MEMBERS TO APPLY)
- Honorary
Corporate Memberships

Corporate memberships are administered by the corporation or firm. The designee is named by the company as the person entitled to membership. There shall only be one designee for each membership, but the designee may be changed, subject to approval and payment of a transfer fee. The membership card will be issued in the name of the approved designee.

As a duly authorized officer of the company, the undersigned certifies and agrees that said company unconditionally guarantees all dues and charges due and payable to The 1818 Club incurred by:
Designee Name
First Last
Company Name
Officer Name
First Last
Officer Signature
Date Signed
Month
Day
Year
Payment of Account

Payment of the account is due upon receipt of the monthly statement. I agree to pay the account when due; and I agree the Club may assess a late charge for past due accounts as provided in the House and membership Rules of the Club as periodically amended. I agree to pay all reasonable attorney fees, investigator fees and costs in the event that this account is turned over for collection.

Bylaws

I agree to conform to and be bound by Bylaws and the House and membership Rules of the Club, as in effect or as they may be periodically amended.
Member Signature
Date Signed
Month
Day
Year
Email
This field is for validation purposes and should be left unchanged.

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Contact Info

receptionist@the1818club.org
(770) 232-1818
6500 Sugarloaf Parkway Duluth, GA 30097

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