Membership Application Form Feb 2024

Membership Application

To apply for membership, please complete all questions.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
example@example.com
Date of Birth

MonthDayYear
Date
Home Number
Mobile Number*
Work Number
Completed Education Level*

Undergraduate degreeGraduate degreeLaw degreeMedical degreeDoctoral degreeOther
Are you active on social media? Check all that apply and list your account names below.*

LinkedinFacebookInstagramTikTok
Linkedin Account
Facebook Account
Instagram Account
TikTok Account
What is your professional status?*

Corporate employeeEntrepreneurUnemployedOther
What is your job title?*
Briefly describe your job responsibilities?*
Are you an entrepreneur?*

YesNo
What is the name of your business?
Briefly describe your business.
List your business' website.
Have you ever been a member of a dinner club? If yes, list the name of the club below.*
Are you a member of other social organizations? List names below.*
Why is Dine Couture of interest to you?*
Provide one current member to nominate you for membership.*
Best availability for a 30 minute 1:1 meet and greet.*

Morning (10 - 12 p.m.)Afternoon (1 - 4 p.m.)Evening (6 - 8 p.m.)
Thank you for your interest in Dine Couture, the premier fine dining dinner club for modern, professional women seeking to upgrade their social lives and expand their social networks.

By submitting this application, you are acknowledging your awareness of the annual membership fee of $1,500.

A member of our team will be in touch with you to schedule a virtual meeting to get to know you better.

Your application will be reviewed within 72 hours.
Your information will not be shared and will be kept safe and confidential. By proceeding, you agree to Dine Couture's Terms and Conditions and Privacy Policy.
Please verify that you are human*
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