Your Application for Membership of 67 Pall Mall Melbourne

Your Application for Membership of 67 Pall Mall Melbourne

Pre-opening offers are available. Joint membership applications can only be processed after the primary Member’s application has been completed.

Personal Details
Title
Full Name

Given Name(s)Family Name
DATE OF BIRTH

DayMonthYear
2 digit day, 2 digit month, 4 digit year
GENDER
PREFERRED CONTACT NUMBER

country code
COMPANY CONTACT NUMBER

COUNTRY CODE
Email Address
RESIDENTIAL AddreSS
STREET ADDRESS
STREET ADDRESS LINE 2
SUBURB
STATE
POST CODE
Street Address

Address Line 2

CityState

Postal / Zip CodeCountry
Nationality
How did you hear about 67 Pall Mall Melbourne?
Preferred method of contact
Proof of identification

Please upload authorised form of photographic identification (e.g., passport or driver license).
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Proof of Address

PLEASE UPLOAD A COPY OF YOUR RECENT UTILITY BILL, BANK STATEMENT OR DRIVER LICENSE.
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Photo

This photo will be used solely for the creation of your Member profile and for internal purposes only. Please ensure the photo is in the format of a passport-sized image.
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Occupational Sector
OCCUPATIONAL SECTOR
Occupational Title
Others
Company Name
Company ADDRESS
STREET ADDRESS
STREET ADDRESS LINE 2
SUBURB
State
POST CODE
Street Address

Street Address Line 2

CityState

Postal / Zip CodeCountry
Personal Assistant Details (If Applicable)

First NameLast Name
EMAIL ADDRESS
CONTACT NUMBER

COUNTRY CODE
Membership

	Annual Fee - Pre Opening	Joining Fee - Pre Opening	Annual Fee - Post Opening	Joining Fee - Post Opening
MEMBERSHIP OF 67 PALL MALL MELBOURNE	A$3,500	A$2,250	A$5,250	A$3,500
JOINT MEMBERSHIP	A$500	Waived	A$1,000	Waived
UNDER 35 MEMBERSHIP	A$2,350	A$2,250	A$4,500	A$3,500
UNDER 30 MEMBERSHIP	A$1,750	Waived	A$2,250	Waived
WINE PRO MEMBERSHIP	A$1,750	A$2,250	A$2,250	A$3,500

I wish to apply for:
Primary Member Details

Please ensure that the details correspond to an active Member. Joint membership applications can only be processed after the primary Member’s application has been completed.
PRIMARY FULL NAME

First NameLast Name
EMAIL ADDRESS
Biography

THE BIOGRAPHY PROVIDED BELOW WILL SERVE TO SUPPORT YOUR APPLICATION.
Biography
TO ASSIST OUR TEAM IN GETTING TO KNOW YOU BETTER, WE KINDLY REQUEST THAT YOU PROVIDE A FEW SHORT PARAGRAPHS ABOUT YOURSELF. THIS WILL HELP US UNDERSTAND YOUR UNIQUE BACKGROUND AND INTERESTS.
To help us better understand your preferences and match you with the most appropriate event, kindly fill out the information below.
Wine Preference
RED VARIETALS
WHITE VARIETALS
COUNTRY
FRENCH WINE REGIONS
ITALIAN WINE REGIONS
AUSTRALIAN WINE REGIONS
SPANISH WINE REGIONS
Personal Interests
Other Personal Interests
Dietary Requirements

Other
WERE YOU REFERRED BY A MEMBER?
REFERRING MEMBER'S NAME
Thank you for your application to 67 Pall Mall Melbourne. As our Membership continues to grow, the joining fee is now AUD$2,250, with incremental increases leading up to the full AUD$3,500 joining fee when the Club opens.

I acknowledge that once the Club is open, my membership fees will be determined by my tier category and that the pre-opening fee schedule will no longer apply.

I acknowledge that my Membership of 67 Pall Mall Melbourne requires annual renewal. While the Club remains in its pre-opening period, my first renewal will be due 12 months from the commencement of my Membership and will be offered at a preferential annual rate that preserves the financial benefit of joining early. Upon the Club’s opening, the advertised annual full fee Membership will be AUD$5,250, or the applicable annual fee corresponding to your specific Membership category.

I acknowledge that 67 Pall Mall Clubs in Australia are currently in development, with projected opening dates subject to change due to unforeseen circumstances or factors beyond 67 Pall Mall's control.

I hereby apply for membership of 67 Pall Mall Melbourne (“The Club”). Should my application 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 to make appropriate due diligence enquiries in relation to my application.
By checking this box and signing below, I declare that the information provided in this application is, to the best of my knowledge, true, accurate and complete. I further acknowledge and confirm that I have read, understood and agree to be bound by the acknowledgements, terms and conditions set out above.
Signature
Application Date

DayMonthYear
2 digit day, 2 digit month, 4 digit year
How did you hear about 67 Pall Mall Melbourne?
Full Name

First NameLast Name
Email Address
I wish to apply for:

	ANNUAL FEE	PRE-OPENING OFFER
MEMBERSHIP OF 67 PALL MALL MELBOURNE	A$4,500	A$2,300
UNDER 35 MEMBERSHIP	A$2,970	A$2,300
UNDER 30 MEMBERSHIP	A$2,350	A$2,300
WINE PRO MEMBERSHIP	A$2,250	A$1,500
JOINT MEMBERSHIP	A$1,000	A$500
JOINING FEE	A$3,500	Waived

Favourite Regions of Wine
Photo

for internal use only
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RESIDENTIAL Address
STREET ADDRESS
ADDRESS LINE 2
Should be Empty:

Your Application for Membership of 67 Pall Mall Melbourne

Personal Details

Membership

Primary Member Details

Biography

To help us better understand your preferences and match you with the most appropriate event, kindly fill out the information below.