Membership Application – Kitchi Gammi Club

Young Professional

$187.50 / Month

Ages 21–40

One-time initiation fee: $500

Resident

$365 / Month

Age 41 and Over

One-time initiation fee: $2,500

Non-Resident

$220.50 / Month

50+ miles from the club

One-time initiation fee: $1,500

Application for Membership

Primary User

Please fill out all the information for Primary & Spouse, if applicable

Residency

Resident

Non-Resident

I hereby submit this application for the following named person(s), and offer the following facts concerning each such person(s):

Name of Primary User(Required)

First Last

Business Name

Position

Nature of Business

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Phone

Opt-in to our Club's Email Blasts(Required)

Yes

Resident Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone(Required)

Date of Birth(Required)

Universities and Graduate Schools

City/Golf Club Memberships

Civic or Arts Involvement

Non-Profit Involvement

Business and Professional Associates

Applicant's Children

Names, Birthdates, Gender

Primary Phone Number

Home

Business

Spouse

Name of Spouse

First Last

Anniversary Date

Business Name

Position

Nature of Business

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Phone

Opt-in to our Club's email blasts

Yes

Resident Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Date of Birth

Universities and Graduate Schools

City/Golf Club Memberships

Civic or Arts Involvement

Non-Profit Involvement

Business and Professional Associates

Applicant's Children

Names, Birthdates, Gender

Interests

The Club is host to many family, business & social events. Please let us know what your interests might be, and we will connect you by sending you targeted emails based on your interests. Please check all that apply.

Interests

Other Interests

Please list other areas of interest, special events you would like to see at the club, or any other information that would help us to connect you better.

Executive Assistant

Please indicate the name of the individual(s) responsible for arranging off-site meetings/parties, overnight guestrooms and/or other reservations along with the phone number and email.

Name

First Last

Phone

Accept

Primary User Signature(Required)

Date(Required)

Spouse or Co-Applicant Signature

Date

Consent for Membership Booklet

I Consent

I Do Not Consent

The Kitchi Gammi Club publishes a membership booklet to its members. We ask for your consent to disclose the primary member’s contact information, which may include email address and telephone number, in this publication.

Please submit an individual photo with your application(Required)

Max. file size: 2 MB.

Payment Options(Required)

Credit Card – (3%convenience fee)

Auto Debit

The Kitchi Gammi Club issues monthly statements for dues and charges incurred. These statements will be mailed to you. Payment is due by the 20th of the following month. The Club offers its members the convenience of the following methods of payment. Please be assured we respect the confidential nature of the financial information you provide.

Statement Notification(Required)

Mail – Home Address

Mail – Business Address

Both Mail and Email

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