Single Gourmet DFW Membership ApplicationAll 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) 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 Circle one: May we use your photo on our website? Yes No
VISA
/ MasterCard / Discover / AMEX # _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Cardholder's Name_______________________________________________________________ Fax
to 214-434-1897 or mail with credit/debit card info. Terms & Conditions
___ 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 |