MEMBERSHIP APPLICATION FORM
(Fiscal year 2012:
September 2011– August 2012)
Joining the American Club of
Please fill out the form as completely as possible. Sign it and date it. If possible, have your
application signed by one or two active members. If you do not yet personally know any active
members, you can meet sponsors at the cocktail for Prospective New Members.
Please include with the application form a copy
of a picture ID (passport, license, etc.)
Return the form along with your initiation fee to the
Club’s office (noted below). Someone
from the Membership Committee will contact you to invite you to the periodic
Prospective New Member Cocktail, or otherwise make arrangements to meet with
you.
Your
application for membership will be processed in accordance with Club By-Laws
and presented for approval to the Executive Committee. You are welcome and encouraged to participate
in Club activities from the time of application, which allows you the
opportunity to become acquainted with the Club and its members.
Title:
_______ First Name: _____________________
Last Name: _____________________________________
(Note: The following two
items are for statistical demographic purposes and NOT to be published: )
Nationality: __________________ Year of Birth:
________________
Occupation: _____________________________ Type of business: _____________________________________
Home/Residence
Address: _________________________________________________________________ Postal Code:
Phone: (+ _____) ___________________Fax: (+ _____) ________________ Mobile: (+____) ________________
Business
Company: _____________________________________________________________________________________
Address: __________________________________________________________ Postal Code: ________________
City: ______________________Country: ______________ Email: _______________________________________
Phone:
(+ _____)
___________________Fax: (+ _____) ________________
How you would like to receive Club notices: Email_____ Fax_____
Regular Mail ____ (€30 extra per year)
Where notices should be sent: Residence
______ Office _______
Pursuant
to the law of January 6, 1978, you have the right to access, correct, update or
delete any personal information concerning you by writing to secretary@americanclubparis.org
Your areas of interest,
expertise, experience: Politics ______Culture ______Business_____
Other______
________________________________________________________________________________________________________
Tell us a little bit about
yourself and your connection with the
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
I wish to apply for membership to the American Club
of
Date: _________________ Applicant
Signature: __________________________________________
Initiation Fee: Regular Member € 160 / Junior Member 35 years old & under:
€ 50 / Diplomat: no fee
Annual Dues: Regular Member/Diplomat € 185 / Junior Member 35 years old & under: €150
Annual Dues if you
live outside
Sponsored by__________________________________Signature________________________________________
Seconded by __________________________________Signature________________________________________
Initiation
Fee Paid (amount) ____________ Annual Dues Paid (amount) ____________
Official Club Use Below:
Approved: Membership Committee-Date:
_________________ Executive
Committee-Date: _________________
34, avenue de
E-mail: secretary@americanclubparis.org - Website: www.americanclubparis.org
ASSOCIATION
REGIE PAR LA LOI DE 1901