Application form for 67 Pall Mall Bordeaux

Application for membership of 67 Pall Mall Bordeaux
Please be assured, all the information you provide is treated with the utmost confidentiality and is solely for the purpose of administering your membership at 67 Pall Mall. It will not be shared with any third parties.
Personal Details
YOUR FULL NAME*

TitleFirst NameLast Name
YOUR ADDRESS*

Address line 1

address line 2

Address line 3Address line 4

Postal codeCountry
LANDLINE NUMBER
MOBILE NUMBER*
EMAIL ADDRESS*
DATE OF BIRTH*

DayMonthYear
NATIONALITY
OCCUPATIONAL SECTOR*
COMPANY NAME
COMPANY ADDRESS

address line 1

address line 2

address line 3address line 4

Postal codeCountry
PERSONAL ASSISTANT DETAILS (if applicable)

First NameLast Name
CONTACT NUMBER
EMAIL ADDRESS
PERSONAL INTERESTS*
OTHER PERSONAL INTERESTS
DIETARY REQUIREMENTS
Membership
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Membership of 67 Pall Mall bordeaux
€2,400.00



Joint Membership of 67 Pall Mall Bordeaux
€2,900.00



Under 35 Membership
€1,800.00



Wine professional Membership
€1,200.00



Under 30 Membership
€1,200.00



Equity Life Membership
€50,000.00



Two Equity Life Memberships
€100,000.00



Three Equity Life Memberships
€150,000.00



Four Equity Life Memberships
€200,000.00



Five Equity Life Memberships
€250,000.00
Joining Fee will be waived for the first 500 applicants.

Equity Life Members benefit from a worldwide Membership of 67 Pall Mall Clubs, with no additional fees to pay.

A limited number of Equity Life Memberships are available for 67 Pall Mall Bordeaux SAS, with a minimum investment of €50,000 and a maximum participation of €250,000.

Equity Life Membership is strictly limited, and is at the discretion of the Company, and may be withdrawn at any time.
Joint Member Details
Please confirm your spouse/partners full name and email address so we can reach out for further details
Full Name

First NameLast Name
Email address
Biography
The biography you provide below will be used to support your application.
Photo

to be used for internal uses only
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Proposer

First NameLast Name
Seconder

First NameLast Name
I hereby apply for membership of 67 Pall Mall Bordeaux ("The Club"). Should my application for membership be approved, I agree to be bound by the Club Rules, by signing this agreement I give my consent for the processing of my personal data as outlined in the Club's Privacy Policy, and for my information to be used for internal Club purposes only. Additionally, I authorise 67 Pall Mall Bordeaux to make appropriate due diligence enquiries in relation to my application.
Signed

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Dated

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Date
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Application for membership of 67 Pall Mall Bordeaux

Personal Details

Membership

Joint Member Details

Biography