Prospective Member Form

Form Designer

TO BE FILLED OUT BY PROSPECTIVE MEMBER

Preferred name to be known by:

Nickname:

Preferred name for use on formal invitation:

Date of Birth:

Mailing Address:

Email:

Billing Address:

Home Phone:

Seasonal Address:

Cell Phone:

Emergency Contact/Phone Number: (will not be published):

Years of residence in Chicago area:

Current Occupation of prospective member:

Business name:

Business address:

Business email:

Former Occupation or Professional Experience:

Spouse/Domestic Partner Name:

Occupation of Spouse/Domestic Partner:

Business name:

Business address:

Cell Phone:

Names, birth dates, and schools of children, step-children, grandchildren and step-grandchildren and cities in which the children are living: (Please indicate whether they are children or grandchildren)

Have any of these children participated in any classes or WAC-Y Camps sponsored by a current member? If yes, please list member name.

Why would you like to become a member of the Woman's Athletic Club? (Minimum 150 Words)

Educational history:

Distinctions:

Family and/or individual club memberships:

Professional Boards and Civic Organizations (positions held):

Activities and Interests:

Have you applied for membership at the Woman’s Athletic Club in the past?

If yes, when and why was the membership process not completed?

Relatives who are past or present members of the Club: (mother, mother-in-law, sisters, sisters-in-law, or other relatives)

Is the applicant aware of any issues or conflicts with a member of the Club, which might affect the application process?

YES

If yes, please explain.

Please attach/upload headshot to application.

Choose

My name is proposed with my consent. All information provided by me in this application is true and complete. I agree to assume responsibility for any indebtedness I incur as a member according to the by-laws and house rules.

Electronic Signature

Date:

Submit

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Prospective Member Form

Prospective Member Form

Form Designer

TO BE FILLED OUT BY PROSPECTIVE MEMBER