THE Cocktail Club: New Member Nomination Form

Proposed Member's Information

Proposed Member's Name

First Name

Last Name

Proposed Member's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Proposed Member's Email Address

Proposed Member's Cell Phone

(###)

###

####

Proposed Member's Photo

Please make sure to name the photo file with the proposed member's first and last name

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Your Information

Please provide a brief explanation of why this person would be an active member of The Cocktail Club

Proposal Submitted By

Date Submitted

YYYY

This is an application for membership only. Current Cocktail Club voting procedure will determine final membership.
The Cocktail Club and its members are not liable for any damages associated with membership or application for membership.