Membership Application.

Instructions

Please complete the application by submitting all the fields below. Once you submit your application, a copy of your application will be sent to you via email.

Please allow 3-5 business days for our Member Rewards Team to review your application. Once your application has been reviewed, you will be notified via email of the status of your application.

Please Note: The information submitted will not be shared with any third-parties.

REFERRAL CODE

Provided by a MyVIPClubs Affiliate


PERSONAL INFO

First Name*

Last Name*

Email*

Please Note: The information below is not required, but extremely important so we may provide you relevant membership benefits, rewards and deals based on your response. For example, if you are a male MyVIP member, we would not want to notify you of a deal for women shoes. That is.. unless you are into that kinda thing.. 😉

Gender

Age Range

CONTACT INFO

Address*

City*

State*

Zip Code*

Cell Phone*

Alternate Phone


COMPANY

Company Name*

POSITION

Title*

INCOME

Annual Salary*


FAVORITE VENUES

Please Note: Although the information below is not required, please share with us the following information so we may continue to grow our list of "Premier Venues" and local businesses within our network. Remember, our goal is to ensure our members receive the best quality service, hospitality and rewards they deserve upon every visit. Your feedback in extremely valuable and we appreciate the information you are providing.

First Venue

Venue Name

Venue City

Venue State

Tell Us Why

Second Venue

Venue Name

Venue City

Venue State

Tell Us Why


Lifestyle

The following questions are very important as they help us to understand the membership benefits, rewards and deals you would like to receive and are relevant to your specific needs.


Types of Dining Venues Preferred*
Hold down the control (ctrl) or command button to select multiple options

Dining Average Spend per Occasion*

Types of Entertainment Preferred*
Hold down the control (ctrl) or command button to select multiple options

Entertainment Average Spend per Occasion*

SOCIAL MEDIA

Please provide the URL to your social media profile(s) so we may get to know you a little better. For example, "https://www.linkedin.com/in/john_doe"



LinkedIn Profile URL*


Facebook Profile URL


Twitter Profile URL


Google Plus Profile URL