Membership Application Form

We will treat your information strictly private and use your data just for the purpose of the Konrad Lifestyle membership application and management of the circle activities, once you have been affiliated as a Konrad Lifestyle member.

Your Name* This field is required.First & Last Name

First Name

Last Name

Name of your PartnerIf applicable

First Name

Last Name

Date of Birth* This field is required.Write your birth date here

DD.MM.YYYY

Home Address* This field is required.Where you live (home address)

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

E-mail* This field is required.

Mobile Number* This field is required.Our communication is very much based on mobile phone & WhatsApp

Country Code

Area Code

Phone Number

Work Phone NumberWhere we can reach you best beside your mobile phone

Country Code

Area Code

Phone Number

Your Profession and Title* This field is required.

In which Industry/Business are you in?* This field is required.Thank you for a short description

WebsiteOf your workplace or your company

What do you like?* This field is required.Mark what is appropriate

Wine

Champagne

Rare Wines & Champagnes

Spirits/Liquors

Cigars

Art

Music

Fine Food

Cars

Jewellery

Watches

Party

Interior & Accessories

Surprises

Dancing

Private Jet Experiences

Other

You and Wine* This field is required.Mark what applies to you

I have a wine cellar at home

I have a wine cooler in my wine cellar

I have a wine cooler in my kitchen/living room

My wine inventory is under 1'000 bottles

My wine inventory is above 1'000 bottles

I am a collector of Champagne

I am a collector of rare wines/formats

I am interested in wine tastings

I am interested in VIP wine/champagne trips

Other

You on Social MediaEnter your respective names

Instagram

Facebook

Twitter

Xing

Your Partner on Social Media(if applicable enter her/his respective names)

Instagram

Facebook

Twitter

Xing

Questions to get each other known* This field is required.Thank you very much for completing our questions

Any comment from your side?Feel free to tell us...

Picture of you (and your partner)* This field is required.Upload here

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Your Identity* This field is required.Take a photo of any valid card of identification (driving license, ID or passport)

WHAT ARE THE NEXT STEPS

We will check your request and give you a feedback on the further procedure within 14 days.

If everything fits so far, Antoine Konrad invites you personally to our KONRAD Member Club at the KONRAD House of Wine & Art Gallery in Basel (Biel-Benken) to get to know each other personally (should this not already be the case) and to present the possibilities of a membership and our member concept in detail.

If our mutual ideas of a membership in our limited Circle coincide, there will be no more obstacles for a KONRAD membership.

You have the choice between 3 Konrad Member Leagues* This field is required.Tell us, which one you are the most interested in. The Membership fee is for one year and starts at the closure of a Membership agreement. The fees below include a yearly consumption credit and a value of goods in your personal Trésor (prices w/o VAT + CHF 1'000 initial one time registration fee).

Silver (CHF 2'900 per year + CHF 1'000 one time registration fee)

Platinum (CHF 9'900 per year + CHF 1'000 one time registration fee)

Gold (CHF 6'900 per year + CHF 1'000 one time registration fee)

Signature Date

Date

Signature* This field is required.

Clear

Membership Application Form