Single Gourmet DFW — Membership Application

All information is for the exclusive use of Single Gourmet DFW and will NOT be sold.

Annual Dues (12 Months) $195

Circle your title and gender:     Ms.    Mr.     Dr.          Gender:  M      F

Name: ___________________First      ____________________Last      _______________Nickname

Address:________________________________________________________________

City:_______________________________     State: _________________       ZIP:_____________

Daytime Phone:_______________   Cell Phone: :________________  Night phone:________________

e-mail:____________________________________________________(e-mail required for membership)

Circle one: Marital Status:   Divorced    Never Married    Widowed    Separated

Age Range (30 - 69) D.O.B:___________    ________   ____________ (Mo/Day/Year — used for seating purposes only)

Profession:____________________________     Employer:_______________________________

What is your motivation for joining Single Gourmet DFW?________________________________

Circle which of these events interest you:  Wine Tastings    Cooking Classes

Three hobbies or interests:_________________________________________________

Circle one: How did you hear about us?  Website    Friend    Pegasus News    8 at 8    Newspaper    Brochure    Other

                  Friend, publication or other (if applicable)____________________________

Circle one: May we use your photo on our website?   Yes       No

Monthly newsletters e-mailed. Check e-mail regularly for event updates.

VISA / MasterCard / Discover / AMEX # _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _

Exp. Date_____/_____(Mo/Yr)   Card ID Number (3 or 4 digit # on front or back of card) _ _ _ _ 

Cardholder's Name_______________________________________________________________

Fax to 214-434-1897 or mail with credit/debit card info.

Terms & Conditions

Initial each line, check the box below and sign the membership application to confirm that the data provided above is accurate and true, and that I understand the following:

___ Annual membership runs for 12 months and expires on the last day of the month

___ Event prices additional and range from $29 (socials); $59 (dinners), $69 (cooking classes) and $89 (wine dinners)

___ Only credit and debit cards accepted for membership and event registration

___ Events charged upon receipt of reservation; payment never accepted at the door