50 Vanderbilt Avenue, New York, NY 10017 Tel: 212-716-2293 Fax: 212-716-2134 info@yaleclubnyc.org www.yaleclubnyc.org MEMBERSHIP APPLICATION FOR YALE UNIVERSITY GRADUATE Personal Information: □ Dr □ Mr □ Mrs □ Ms □ Other _ First Name: Last Name: Email: _ Telephone: ( ) - D.O.B. / _/ _ Home Address: _ City: State: Zip: _ Country: _ Business Address: _ City: State: Zip: _ Country: _ Send correspondence to: □ Home □ Business School Information: Year You Received Your Undergraduate Degree: _ Institution: _ Other Degrees: Degree: School: _ Year: Degree: School: _ Year: Degree: School: _ Year: Spouse/Domestic Partner Information: Please fill in your spouse/domestic partner’s information if you would like them to have signing privileges There is a $103.43 annual charge (March – February 28) for the signing privilege This fee is not prorated This signing privilege allows your spouse/domestic partner to get their own account number and use the Club without the primary member being present Only one signing privilege account is allowed per primary account Spouse: □ Dr □ Mr □ Mrs □ Ms □ Other _ First Name: Last Name: _ Yale Graduate Web Application Email: _Telephone: ( ) - D.O.B. / _/ _ Home Address: _ City: State: Zip: _ Country: _ Survey Information: How did you hear about the Club? (Please check all that apply.) □ Attended a Club Event □ Attended a Private Event □ Current Member □ Previous Mailing □ Prospective Member Reception □ Senior Class Reception □ Member of DKE fraternity □ Stayed Overnight □ Summer Happy Hours □ Summer Student Membership □ Was a Previous Member □ Website □ While at Yale □ Word of Mouth □ Yale Alumni Magazine □ Other _ Interests (Please check all that apply.) □ Architecture □ Art □ Book Club □ Chorus □ GLBT Events □ Golf □ Lectures □ Opera □ Pilates □ Personal Training □ Speakers □ Sporting Events/Tickets □ Theater □ Tours of NYC □ Women’s Events □ Yoga □ Athletics □ Cycling □ Governance/Committees □ Outdoor Conditioning □ Running □ Squash □ Triathlons □ Other _ □ Ballet □ Dining □ Jazz □ Parties □ SIGs □ Tastings □ Wine Athletic Package Information: Sign here if you would like to add the Athletic Package to your membership The Athletic Package is $499 annually ($347.25 for 2009 undergrad graduates, $249.50 for 2010 undergrad graduates and $0 for 2011 undergrad graduates) You must optinto the athletic package in order to have it □ I would like to sign up for the Athletic Package Signature: _ Payment Information: • • • Payment of the initiation fee and one quarters dues or pro-rated quarters dues (dues will be prorated according to the month in which you join and if you join in a month in the middle of a quarter) must be submitted with application Please make all checks payable to The Yale Club of New York City Membership at the Yale Club is non-refundable and non-transferable [ ] American Express [ ] MasterCard [ ] VISA [ ] Check Credit Card Number Expiration Date _ Signature: _ Date: / _/ _ [ ] I would like to set up my credit card for automatic bill pay The credit card will be charged between the 15th and 30th of every month Yale Graduate Web Application ... Information: Sign here if you would like to add the Athletic Package to your membership The Athletic Package is $499 annually ($347.25 for 2009 undergrad graduates, $249.50 for 2010 undergrad graduates... the middle of a quarter) must be submitted with application Please make all checks payable to The Yale Club of New York City Membership at the Yale Club is non-refundable and non-transferable... I would like to set up my credit card for automatic bill pay The credit card will be charged between the 15th and 30th of every month Yale Graduate Web Application