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
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

I wish to apply for:*

Membership of 67 Pall Mall MelbourneJoint MembershipUnder 35 MembershipUnder 30 MembershipWine Pro MembershipLife Membership
WE APPRECIATE YOUR INTEREST IN BECOMING A LIFE MEMBER WITH US. OUR TEAM WILL BE IN TOUCH WITH YOU SHORTLY. THANK YOU.
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 *

FORTIFIEDREDSPARKLINGSWEETWHITEROSE
RED VARIETALS*

PINOT NOIRSYRAH/SHIRAZCABERNET SAUVIGNONMERLOTMALBECCABERNET FRANCGAMAYNEBBIOLOSANGIOVESEGRENACHEMOURVEDRE/MATARO/ MONASTRELLTEMPRANILLO
WHITE VARIETALS*

CHARDONNAYCHENIN BLANCRIESLINGSAUVIGNON BLANCPINOT GRIS/PINOT GRIGIOSEMILLONALIGOTEVERMENTINOFIANOSOAVE/GARGANEGAVERDEJOALBARINOPALOMINOMARSANNEROUSSANNEVIOGNIER
COUNTRY*

FRANCEITALYURUGUAYSPAINAUSTRALIAGEORGIAARMENIASOUTH AFRICACHINAPORTUGALLEBANONGERMANYJAPANTURKIYEAUSTRIAUNITED STATES OF AMERICASWITZERLANDGREECEHUNGARYNEW ZEALANDARGENTINAENGLANDCHILE
FRENCH WINE REGIONS*

CHAMPAGNEALSACEBURGUNDYLOIRERHONE VALLEYBORDEAUXSAUTERNESPROVENCEFRENCH WINE IN GENERAL
ITALIAN WINE REGIONS*

PIEDMONTTUSCANYSICILYVENETOLOMBARDYALTO ADIGE/TRENTINOUMBRIASARDINIAMARCHEABRUZZOCALABRIALAZIOITALIAN WINE IN GENERAL
AUSTRALIAN WINE REGIONS*

MARGARET RIVERGREAT SOUTHERNHUNTER VALLEYLANGHORNE CREEKCLARE VALLEYBAROSSA VALLEYEDEN VALLEYMCLAREN VALEADELAIDE HILLSCOONAWARRAGEELONG/BELLARINEHEATHCOTEMACEDON RANGESYARRA VALLEYMORNINGTON PENINSULABEECHWORTH/KING VALLEYTASMANIAGRANITE BELTCANBERRAAUSTRALIAN WINE IN GENERAL
SPANISH WINE REGIONS*

RIOJAPENEDESRIBERA DEL DUEROGALICIAPRIORAT
Personal Interests

AFLARCHITECTUREART & DESIGNCARD OR BOARD GAMESCARSCHEESECIGARSCOOKINGCYCLINGDANCEENTREPRENEURSHIPENVIRONMENTALISMFASHIONFILM & TELEVISIONFINE DININGFITNESSFRAGRANCESGARDENINGHEALTH & MINDFULNESSHORSE RACINGINTERIOR DESIGNJEWELLERYLITERATURE, READING & WRITINGMOTOR SPORTMUSICNATUREPETSPHOTOGRAPHYPOETRYPOP UP EVENTS & FESTIVALSPOTTERYRUGBY LEAGUERUGBY UNIONSELF DEVELOPMENTSHOPPINGSOCCERSOCIAL DEVELOPMENTSOCIALISINGSPORTSSTAND-UP COMEDYTENNISTHEATRETRAVEL & CULTURETRIVIAVINYL RECORDSVOLUNTEERING & PHILANTHROPYWATCHESWHISKY & RUMYACHTSYOGA
Other Personal Interests
Dietary Requirements

DAIRY FREEEGG ALLERGYFISH ALLERGYGLUTEN FREEKETOGENICLACTOSE FREENUT ALLERGYPALEOSHELLFISH ALLERGYVEGANVEGETARIANOther
WERE YOU REFERRED BY A MEMBER?*

YESNO
REFERRING MEMBER'S NAME*
We are thrilled to announce that our active Founding Membership base has now reached the 500 Member milestone. This means we will now be introducing our joining fee in increments beginning at $750, until we reach our full joining fee of $3,500.

Joint Membership is applicable for spouses/romantic partners of a Primary Member. Joint Members will enjoy full Club benefits for the duration that the Primary Membership is active.

Once the committee has approved your application, you will hear from us again with an invoice for your annual fee to complete your election to the Club.

Kindly note that should circumstances change and you no longer wish to continue your membership with 67 Pall Mall prior to the date of your annual renewal, there will not be a reimbursement of the proportionate part of the annual subscription.

Lifetime Membership is also available in limited slots in Melbourne. If you would like to apply for this membership category, please contact Investor relations directly.
I hereby apply for membership of 67 Pall Mall Melbourne (“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 to make appropriate due diligence enquiries in relation to my application.

67 Pall Mall Melbourne is scheduled to open in Spring-2025, but I understand and acknowledge that this date is not guaranteed and that factors not currently foreseen or within 67 Pall Mall Melbourne’s control may delay the launch.

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.
Signature*

Clear
Application Date

DayMonthYear
How did you hear about 67 Pall Mall Melbourne?*
Full Name

First NameLast Name
Email Address
I wish to apply for:*

Membership of 67 Pall Mall MelbourneUnder 35 MembershipUnder 30 MembershipWine Pro MembershipJoint Membership

	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:

	Annual Fee - Pre Opening	Joining Fee - Pre Opening	Annual Fee - Post Opening	Joining Fee - Post Opening
MEMBERSHIP OF 67 PALL MALL MELBOURNE	A$2,300	A$750	A$4,500	A$3,500
JOINT MEMBERSHIP	A$500	Waived	A$1,000	Waived
UNDER 35 MEMBERSHIP	A$2,300	A$750	A$2,970	A$3,500
UNDER 30 MEMBERSHIP	A$2,300	Waived	A$2,350	Waived
WINE PRO MEMBERSHIP	A$1,500	A$750	A$2,250	A$3,500

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.