Single Gourmet DFW — Membership Application

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

Annual membership: $195 (runs 13 months).
We hold several events monthly throughout the Metroplex.

Circle your title and gender:     Ms.     Miss       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   Travel    Culinary Tours   Dancing

Three hobbies or interests:_________________________________________________

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

                  Publication, friend or promo code, (if applicable)____________________________

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

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 972-250-1840 or mail with credit/debit card info to:
            Single Gourmet DFW
            19009 Preston Road, Suite 215
            Dallas, Texas 75252

Terms & Conditions
Initial each box below and sign the membership application to confirm that the data provided above is accurate and true and that I understand the following:

___ Event prices additional and range from $69 (dinners and cooking classes) and $89 (wine dinners)

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

___ Our guarantee: Join and attend at least two events during the first 60 days. If you feel we're not a good fit, 
      e-mail us your reason and we will issue you a $100 refund