Introductory Offer –- Apply Suburban rates apply immediately Early Bird Special for membership now and prepay for non-NYC newdues members in 2015 your 12 months’ for Julyjoining 1st, 2012 to June 30th, 2013 at Initiation waiver forthe Class of 2015 graduates Early Birdfee Special – Apply for membership nowget and prepay 2011/2012 rates (before rate increase) and free access who join by September 30th, 2015! your 12 months’ dues for July 1st, 2012 to no June 30th, 2013 to the Penn Club after April 1st, 2012 with initiation fee at 2011/2012 (before increase) Participatingrates in this Earlythe Birdrate Special givesand youget as free muchaccess as to the Penn Club after April 1st,Club 2012 with no initiation months’ access to the Penn that is free of dues!fee Participating in this Early Bird Special gives you as much as months’ access to the Penn Club that is free of dues! MEMBERSHIP APPLICATION AFFILIATE MEMBERSHIP APPLICATION Dr Mr Mrs Promo Code: Referral Code: DMGRD11 DM351209 UVMgrad15 Referral Code: DMGRD11 DM351209 Yes, I’d like to participate in Bird Special Yes, I’dthe likeEarly to participate in (offer ends 06/30/11) the Early Bird Special (offer ends 06/30/11) MEMBERSHIP APPLICATION Ms APPLICANT’S FULL NAME Dr NAME Mr WHEN Mrs ENROLLED Ms APPLICANT’S FULL NAME FULL (if different from above) FULL NAME WHEN ENROLLED (if different from above) AFFILIATION* _ SCHOOL YEAR (1st Penn degree, if multiple) AFFILIATION* _ SCHOOL YEAR Brandeis Univ.; Bryn Mawr College; Deerfield Academy; Franklin & Marshall; Gettysburg College; Haverford College; INSEAD; st Penn degree, if multiple) PROGRAM (checkLondon all that apply): Full-Time Part-Time Degree Certificate Johns Hopkins Univ.; Business School; Peddie School; Swarthmore College; Trinity College; Univ of Chicago; Univ.(1of Richmond; *Alumnus; CurrentVanderbilt Student; Univ.; Faculty/Staff/Board or Committee Member Club, of Penn; Parent; Grandparent; Univ of Vermont; Canadian Association ofPart-Time NY*; Chemists’ M.I.T Club*; Vassar Club* Brother, Sister; or Child of PROGRAM (check all that apply): Full-Time Degree Certificate Alumnus; Education with Student applying as Family Member of Alum, list alumnus name, class year and relationship above *Club #: (*Must haveExecutive an active membership theseIfclubs) *Alumnus; Current Student; Faculty/Staff/Board or Committee Member of Penn; Parent; Grandparent; Brother, Sister; or Child of Executive Education Student If applying as Family Member of Alum, list alumnus name, class year and relationship above EAlumnus; MPLOYMENT/PROFESSIONAL INFORMATION: (all information required) Firm/Employer: _ Title: _ EMPLOYMENT/PROFESSIONAL INFORMATION: (all information required) Address: _ Firm/Employer: _ Title: _ City, State, Zip: _ Address: _ Business Phone: _ ) Business Fax: _( _ ) City, State, Zip: _( _ Business _( _ ) Business Fax: _( _ ) INFORMATION : (all information required) PERSONAL Phone: Address: NFORMATION: (all information required) PERSONAL I _ City, State, Zip: _ Address: _ Home Phone: _( _ ) Home Fax: ( ) _ City, State, Zip: _ Email: Cell Phone: Home Phone: _( _ ) Home Fax: ( ) _ ( ) _ Single Married Please send all correspondence to: Business Home Marital Status: Email: Cell Phone: ( ) _ Date of Status: Birth: Social Number: to: - - Single / Married/ Please send allSecurity correspondence Business Home Marital Date of Birth: / / LUB INFORMATION: C Social Security Number: - - Were previously: a member of the Penn Club? No Yes, from _ to _ Member # _ LUB you INFORMATION C Did a you member refer you? Noof theYes , byClub? (whom) No Were previously a member Penn Yes, from _ to _ Member # _ Did a member refer you? No Yes, by (whom) POUSE MEMBERSHIP : S If you wish to receive a separate spouse membership, please complete the following section SPOUSE MEMBERSHIP: If you please complete the following section Dr wish Mr.to receive Mrs a separate Ms FULLspouse NAMEmembership, _ Date of Birth: / / Social Security Number: - - Dr Mr Mrs Ms FULL NAME _ Daytime Telephone: _( _/ ) _ Wedding Anniversary: / / Date of Birth: / Social Security Number: - - Email: Cell Phone: ( ) _ Daytime Telephone: _( _ ) _ Wedding Anniversary: / / Email: Cellmembers Phone: ( ) _ FITNESS CENTER MEMBERSHIP For an additional yearly fee, may add the Palestra Fitness Center to their PALESTRA two (2) account New members of the Palestra are provided three (3) complimentary Fitness Evaluation/Personal Training Sessions Palestra ALESTRA FITNESS CENTER MEMBERSHIP For an additional yearly fee, members may add the Palestra Fitness Center to their P dues are billed quarterly based on a yearly contract, and charged to your house account upon entrance to The Penn Club account New members of the Palestra are provided three (3) complimentary Fitness Evaluation/Personal Training Sessions Palestra Yes, will join the Palestra Center Upon thehouse account for:uponmyself myThe spouse dues areI billed quarterly based onFitness a yearly contract, and entry, chargedcharge to your account entrance to Penn Club Yes, I will join the Palestra Fitness Center Upon entry, charge the account for: PAYMENT INFORMATION myself my spouse (Payment must be submitted with application CREDIT CARD information REQUIRED even if paying by check.) PAYMENT INFORMATION Americanmust Express MasterCard VISA CREDIT Check No.information Amounteven $ _ (Payment be submitted with application CARD REQUIRED if paying by check.) Applicant/Cardholder Name (required) American Express MasterCard VISA Check No Amount $ _ (required) Exp Date / Credit Card NumberName Applicant/Cardholder (required) All payments for membership must include 8.875% New York State Sales Tax added to both dues and fees will be proI authorize The Penn Club to automatically bill myth credit card for membership duesExp on initiation aDate yearly basisDues / (required) Credit Card Number st rated according to our fiscal year beginning July to June 30 Please make checks payable to The Penn Club Valid credit card number All payments for membership must include 8.875% York State Sales Tax added to both dues andnon-transferable initiation fees Dues be promust be provided for processing and verification of New application Membership is non-refundable and Pleasewill allow two rated according to ouroffiscal year beginning July 1stmust to June 30th PleaseIN make to The Penn Club Valid credit card number weeks for processing application Application be completed FULLchecks WITHpayable PAYMENT to be processed must be apply provided for processing verification of application is any non-refundable and non-transferable Please allow I hereby for membership, andand authorize The Penn Club of NewMembership York to make necessary inquiries on the information listed on two this weeks for processing of application Application must be completed WITH PAYMENTinstitution to be processed application as well as to the University of Pennsylvania and/or IN anyFULL other educational to evaluate my application IIfhereby for membership, andtoauthorize The abide Penn by Club New York makerules any necessary on theClub information listedI authoon this electedapply into membership, I agree support and theofby-laws andtohouse as set forthinquiries by The Penn of New York application asClub wellofasNew to York the to University of credit Pennsylvania and/or any other educational institution to evaluate application rize The Penn charge my card on file for payment of house charges that are 90 days past due,my including any If elected into membership, I agree to support and abide by the by-laws and house rules as set forth by The Penn Club of New York I authoapplicable finance fees rize The Penn Club of New York to charge my credit card on file for payment of house charges that are 90 days past due, including any Applicant/Cardholder Signature (required) Date / / applicable finance fees The Penn Club • 30 West 44th Street • New York, NY 10036 • Phone (212) 403-6627 • Fax Date (212) 403-6616 • membership@pennclub.org Applicant/Cardholder Signature (required) / / The Penn Club • 30 West 44th Street • New York, NY 10036 • Phone (212) 403-6627 • Fax (212) 403-6616 • membership@pennclub.org THE GIFT OF MEMBERSHIP If you are purchasing this membership as a gift, please fill out the following information: Gift Giver’s Name: Gift Giver’s Telephone: Gift Giver’s Email: Is this gift of membership a surprise to the recipient? Yes No Gift Recipient’s Name: If you check “Yes”, the new member welcome packet can be mailed to you so that you can present it to your child as a surprise gift Would you like The Penn Club to mail the New Member Welcome Membership Package to the parent or the graduate? Parent/Gift Giver The Graduate (address listed on the application) Please mail the Membership Package to the following address: Attn: Mailing Address: City, State, Zip: Would you like us to enclose a Membership Certificate on your behalf? Yes No If yes, please include the following note on the personalized Membership Certificate: Dear: (30 characters) Message: (100 characters) To facilitate your payment, complete the credit card payment information below and sign at the bottom The gift recipient graduate will receive a membership verification form on which s/he will provide their own credit card information and signature for our files Once the new member comes into the clubhouse as a member, s/he can opt to add the Palestra Fitness Center membership at that time PAYMENT INFORMATION (Payment must be submitted with application CREDIT CARD information REQUIRED even if paying by check.) American Express MasterCard Cardholder Name (required) Credit Card Number (required) VISA Check (Number and Amount) Exp Date I authorize The Penn Club to automatically bill my credit card for membership dues on a yearly basis All payments for membership must include 8.875% New York State Sales Tax added to both dues and initiation fees Dues will be pro-rated according to our fiscal year beginning July 1st to June 30th Please make checks payable to The Penn Club Valid credit card number must be provided for processing and verification of application Membership is non-refundable and non-transferable Please allow two weeks for processing of application Application must be completed IN FULL WITH PAYMENT to be processed I hereby apply for membership on behalf of the gift recipient, and authorize The Penn Club of New York to make any necessary inquiries on the information listed on this application as well as to the University of Pennsylvania and/or any other educational institution to evaluate the application I understand that the member for whom I am gifting this membership must submit their own valid credit card and signature and any missing information for our files within 30 days or the membership may be suspended without refund In the interim, I authorize The Penn Club of New York to charge my credit card on file for payment of house charges that are 90 days past due, including any applicable finance fees, should the member fail to submit this information in a timely basis Cardholder’s Signature (required) Date THE PENN CLUB OF NEW YORK AFFILIATE MEMBERSHIP ANNUAL DUES RATES AND INITIATION FEES Fiscal Year July 1, 2015 – June 30, 2016 Age Category 21-28 years old 29-34 years old 35+ years old Spouse Membership Annual Dues $570 $1225 $1650 Initiation Fee $570 $1225 $1225 $365 N/A Upon attaining 100 dues-paying members from The University of Vermont, the following fiscal year, its affiliate members who not live or work in New York City will be billed the suburban rate: Age Category 21-28 years old 29-34 years old 35+ years old Suburban Annual Dues $390 $850 $1130 Suburban Initiation Fee $390 $850 $1130 MEMBERSHIP PROCESS Completing the Application The Club membership year is July 1st to June 30th Dues will be pro-rated according to the month in which you join Initiation fees are due in full Rates are subject to change Both initiation fees and dues are subject to New York sales tax of 8.875% ALL requested information must be filled out in order to process your application All checks should be made payable to The Penn Club and to the attention to the Membership/Admissions Office Credit card payment is accepted Applications may be dropped off at the front desk, mailed, scanned & emailed or faxed to the attention of the Membership/Admissions Office at (212) 403-6616 If the application is faxed, the original signed application should be mailed to the Membership Office for record keeping Verification of the information on the application will be conducted during the membership acceptance process Annual dues and initiation fees are determined upon thorough review of the information provided Any additional charges that are determined by the membership department must be paid for in advance before the membership process can be completed Please allow two weeks for processing of membership applications Prospective members may not utilize the Club or any of its facilities or reciprocal clubs until notified of acceptance into the Club New members will be notified by mail of their acceptance into the Penn Club The Penn Club y 30 West 44th Street y New York, NY 10036 y Phone (212) 403-6627y Fax (212) 403-6616 y membership@pennclub.org 1-24 d 25 rsity tia- and ** 5 tiation e or ge 25, n OVERNIGHT ROOM RATES STANDARD & DELUXE ROOMS Monday – Sunday per night Standard Queen or two Twin Beds $255.00 Deluxe Queen $270.00 Standard, King $280.00 Deluxe King $300.00 FOUNDER’S SUITE King, Walk-in Closet $400.00 EXTRAS: Guest Fee* Up to $100.00 Rollaway Bed (adult, child) $25.00 Crib $25.00 Sep-Dec Peak surcharge $10.00 Rates subject to change based on market conditions *Guest fee assessed to all rooms occupied by guests of members PALESTRA FITNESS CENTER Palestra Membership (Annual Contract; Fees Billed Quarterly) 21-28 years $110 quarterly / $440.00 annually 29 and over $125 quarterly / $500.00 annually Guest Fee, per visit $ 15.00 Locker and Laundry Full Locker, per year Half Locker, per year Laundry, per year $250.00 $140.00 $155.00 MASSAGE THERAPY 60-Minute Session 90-Minute Session In room, additional Aromatherapy, additional $ 95.00 $140.00 $ 15.00 $ 10.00 PERSONAL TRAINING One-Hour Session sessions 10 sessions 20 sessions SQUASH COURTS at the Yale Club 45 court rental $ 19.00 per player** Guest Fee $ 14.00 per player ** $38.00 minimum (if playing alone) HOURS OF OPERATION PALESTRA FITNESS CENTER Monday – Friday 6:30 a.m – 9:30 p.m Weekend & Holidays 8:00 a.m – 4:00 p.m SQUASH COURTS at the Yale Club Monday – Friday 6:30 a.m – 9:30 p.m Saturday – Sunday 8:30 a.m – 5:30 p.m BUSINESS CENTER Daily 7:00 a.m – 11:00 p.m PRESIDENTS AND PROVOSTS ROOM Monday through Friday (closed during summer) Breakfast 7:00 a.m – 10:00 a.m Lunch 12:00 noon – 2:30 p.m Wed Dinner Buffet 6:00 p.m – 8:30 p.m THE GRILL ROOM Monday through Friday Breakfast (summer only) 7:00 a.m – 10:00 a.m Lunch 12:00 noon – 3:00 p.m Casual Fare 3:00 p.m – 5:30 p.m Dinner 5:30 p.m – 10:00 p.m Bar 12:00 noon – 11:00 p.m Saturday Continental Breakfast 7:00 a.m – 11:00 a.m Lunch 12:00 noon – 7:00 p.m Sunday & Holidays Continental Breakfast 7:00 a.m – 11:00 a.m BENJAMIN FRANKLIN ROOM Library Open Daily $ 85.00 $ 400.00 $ 750.00 $1400.00 (Spinning, Yoga, Pilates, Nutritional Counseling, and Weight-Loss programs also available) 24 hours Monday through Friday Complimentary Coffee 10:00 a.m – 11:00 a.m Kite & Key Bar 4:00 p.m – 10:30 p.m Rates, times and services subject to change at any time Please visit www.pennclub.org for current rates Rev 4/15 ... GIFT OF MEMBERSHIP If you are purchasing this membership as a gift, please fill out the following information: Gift Giver’s Name: Gift Giver’s Telephone: Gift Giver’s Email: Is this gift of membership. .. that are determined by the membership department must be paid for in advance before the membership process can be completed Please allow two weeks for processing of membership applications Prospective... State, Zip: Would you like us to enclose a Membership Certificate on your behalf? Yes No If yes, please include the following note on the personalized Membership Certificate: Dear: (30 characters)