Summer Provisional Member Program Summer Provisional... · Degree (i.e., BA, MA, JD, etc.) Year...
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Date Received: _______________ Summer Provisional Member Number: _____________________________________________ WE NOMINATE THIS APPLICANT FOR MEMBERSHIP: Member Proposer/Member Number E-mail Cell/Work Telephone Numbers Length of Time Known Member Seconder/Member Number E-mail Cell/Work Telephone Numbers Length of Time Known oProposer Recommendation Letter and Photo of Summer Provisional Member must be submitted with application. FULL NAME: Prefix First Middle Last Suffix Nickname Date of Birth Place of Birth Social Security Number ADDRESSES: Industry Title Employer Name Work Telephone Number Employment Address Suite Number Preferred E-mail Address City State Zip Residential Address Home Telephone Number Cell Phone Number City State Zip All Summer Provisional Statements and Social Mail are Emailed to (preferred E-mail address): MARITAL STATUS: Single Married Spouse’s Name Spouse’s Date of Birth Industry Title Employer Name Telephone Number Employment Address Suite Number E-mail Address City State Zip Children’s Names and Date of Birth (Under the age of 21) EDUCATION: University Degree (i.e., BA, MA, JD, etc.) Year Graduated Undergraduate: ___________________________________________________________________________________________________ Graduate School: _________________________________________________________________________________________________ Graduate School(s): _______________________________________________________________________________________________ Are you a Veteran of the U.S. Armed Forces? Branch/Rank & Dates of Service: _______________________________________________ Applicant signature and further information required on back page g THE UNIVERSITY CLUB OF WASHINGTON, DC SUMMER PROVISIONAL Membership Form 1135 Sixteenth Street, NW, Washington, DC 20036 www.universityclubdc.com
Transcript of Summer Provisional Member Program Summer Provisional... · Degree (i.e., BA, MA, JD, etc.) Year...
Dat
e Re
ceiv
ed:
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WE
NO
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ATE
TH
IS A
PP
LIC
AN
T F
OR
MEM
BER
SH
IP:
Mem
ber
Prop
oser
/Mem
ber
Num
ber
E
-mai
l
Cel
l/W
ork
Tele
phon
e N
umbe
rs
L
engt
h of
Tim
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own
Mem
ber
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/Mem
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-mai
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ork
Tele
phon
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umbe
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L
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own
oP
ropo
ser
Rec
omm
enda
tion
Let
ter
and
Pho
to o
f Sum
mer
Pro
visi
onal
Mem
ber
mus
t be
subm
itte
d w
ith
appl
icat
ion.
FULL
NA
ME:
Pref
ix
Fi
rst
Mid
dle
L
ast
Suf
fix
Nic
knam
e
Dat
e of
Bir
th
Pl
ace
of B
irth
So
cial
Sec
urity
Num
ber
AD
DR
ESSE
S:
Indu
stry
Ti
tle
Empl
oyer
Nam
e W
ork
Tele
phon
e N
umbe
r
Empl
oym
ent A
ddre
ss
Suite
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ber
Pre
ferr
ed E
-mai
l Add
ress
City
St
ate
Zip
Resi
dent
ial A
ddre
ss
Hom
e Te
leph
one
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ber
Cel
l Pho
ne N
umbe
r
City
St
ate
Zip
All
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mer
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visi
onal
Sta
tem
ents
and
Soc
ial M
ail a
re E
mai
led
to (p
refe
rred
E-m
ail a
ddre
ss):
MA
RIT
AL
STAT
US:
Si
ngle
Mar
ried
Spou
se’s
Nam
e Sp
ouse
’s D
ate
of B
irth
Indu
stry
Ti
tle
Empl
oyer
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e Te
leph
one
Num
ber
Empl
oym
ent A
ddre
ss
Suite
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ber
E-m
ail A
ddre
ss
City
St
ate
Zip
Chi
ldre
n’s
Nam
es a
nd D
ate
of B
irth
(Und
er th
e ag
e of
21)
EDU
CAT
ION
:
Uni
vers
ity
Deg
ree
(i.e.
, BA
, MA
, JD
, etc
.)
Y
ear
Gra
duat
ed
Und
ergr
adua
te: _
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Are
you
a V
eter
an o
f the
U.S
. Arm
ed F
orce
s? B
ranc
h/Ra
nk &
Dat
es o
f Ser
vice
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App
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t sig
natu
re a
nd fu
rthe
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form
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age g
The
Un
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ClU
b o
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Pr
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embe
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35 S
ixte
enth
Str
eet,
NW
, Was
hing
ton,
DC
2003
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SU
MM
ER
Sum
mer
Pro
visio
nal M
embe
r Pro
gram
Mem
oria
l Day
thro
ugh
Labo
r Day
2015
CLUBS WITHIN THE CLUB OFFERINGS: Our Clubs Within The Club give you a way to share your interests, passions, and hobbies with like-minded members.
Please the Club(s) of your choice to receive relevant information or sign up at www.universityclubdc.com.
Backgammon Club Bridge Club UC Kids Club Cellar Dwellers Wine & Spirits
C.S. Lewis Club Classic Cinema Cafe Classical Music Club ExecWomen’s Forum Fur, Fins & Feathers Fishing & Hunting
UC Golf Club
Great Books Hockey Club UC Lacrosse Club Military History Legion Personal Financial Planning Port, Cigar & Politics (PCP) Proctor Dougherty Society (35 and under)
Ski Club Swim, Bike, Run The Salon Toastmasters
If accepted for membership I agree to abide by The University Club Bylaws and House Rules, including payment in full of all indebtedness is required upon receipt of an invoice. I also understand that, as part of the application process, a credit review/reference check may be performed. If my account is 60 days past due twice in any twelve-month period, credit privileges at the Club will be suspended. If this should occur, I agree that my credit card will be charged routinely for all Club charges. All credit card transactions are subject to a 3% processing fee. I understand that the Club’s Bylaws and House Rules are subject to change, and I agree to abide by any such changes if I am elected to membership.Credit Card Number: _____________________________Card Type: American Express Visa Master Card
Exp. Date: ______________________________________Signature of Applicant
_____________Date
MEMBERSHIP FEES
Membership Categories
Initiation Fee
Monthly Dues
Monthly Food & BeverageMinimum
Resident(age 35 and over)Junior Resident (age 30-34)
Intermediate(age 25-29)
Junior (age 21-24)
Nonresident
Diplomatic Corps
Clergy
(Members who do not reside or have a place of business within 50 miles of the Clubhouse)
(Members as shown by the Diplomatic List published by the Department of State)
(Practicing ordained ministers, priests or rabbis)
$1,500 $302 $100*
$1,000 $244 $75**
$800
$500$800
$500
$750
$117
$58$55
$55
$114
Billed quarterly
/
$50
$25$25 /
$25
$25
/
a
During your time as a Provisional member, you will be charged provisional dues at half your monthly dues rate.
* Resident membership dues will decrease by $100 per month after the first 3 years.
** Junior Resident membership dues will decrease by $85 per month after the first year.
SUMMER PROVISIONALMEMBER PROGRAM
Full use of Club FacilitiesComplimentary use of Athletic Facilities*
*Fitness classes, locker storage and laundry services are additional
Access to 200 Reciprocal Clubs around the WorldWaiver of Food & Beverage Minimum
Signature UClub Provisional Member Events
$350 (age 21-29)$500 (age 30 and over)
This is a one-time opportunity and applicants must be at least 21 years of age.
Applicants must have the endorsement of two active Club members.The Proposer must submit a Letter of Recommendation
for the SPMP candidate.
Memorial Day through Labor Day 2015May 25 - September 7
SPMP includes:
The Athletic Health Club membership is an optional and additional fee for University Club members. The monthly individual fee health club fee
is $47.50 and the monthly family health club fee is $77.50 plus tax.
SUMMER PROVISIONAL MEMBERSHIP CATEGORY YOU ARE APPLYING FOR:
What are your primary reasons for joining? PleaseaDining Fitness Private Events SpaOvernight Accommodations Reciprocity
The SPMP is an ideal way for a prospective member to experience The University Club and connect with members
this Summer before joining in the Fall.
Present/past memberships in clubs and organizations:
Personal interests (hobbies/recreational/intellectual pursuits):
Other:
For more information contact [email protected].
