Young Men's Lyceum Club - NEW Member Application

Young Men's Lyceum Club - NEW Member Application
Type of Membership
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
First & Last Name
First Name
Last Name
Street Address
City
State
Zip
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email address
example@example.com
Phone Number
Format: (000) 000-0000.
Current Occupation
Please provide some details about yourself (family, interests, hobbies, etc)
All NEW members must be sponsored by a current member (in good standing) of the Young Men's Lyceum Club of Tarrytown. Please provide your sponsor's name and contact information below.
Sponsor's First & Last Name
Sponsor's Primary Phone #
Please enter a valid phone number.Format: (000) 000-0000.
Please initial below to acknowledge your acceptance of the Young Men's Lyceum Club of Tarrytown's rules and regulations for prospective new members:
I understand that annual dues of $500 must be submitted with this membership application.
I understand that prospective new members must submit a $200 one-time Initiation fee with this membership application.
I understand that prospective new members shall appear before the Board at the next regularly scheduled Board meeting following the submission of the application, at which time the Board shall vote on whether to formally approve new members and conclude the probationary period.
I understand that prospective new members may be denied membership by (i) three negative ballots from Members in good standing, reported to the Board during the thirty day bulletin board period, or (ii) a majority vote of the Board of Directors.
I verify that the information provided above is accurate to the best of my ability.
Signature
Full Name
I will submit payment via:
Total Amount Paid:
Should be Empty: