New Member Registration Form

BLACK TIE CLUB INTERNATIONAL REHOBOTH BEACH-LEWES MEMBERSHIP REGISTRATION
Name*

Given/Legal First NameLast Name
Preferred First Name (Optional)
E-mail*
Mobile Phone Number*
Home Phone Number (Optional)
Partner/Husband Name

Given/Legal First NameLast Name
Partner/Husband Preferred First Name (Optional)
E-mail (2)
example@example.com
Mobile Phone Number (2)
Primary Address*

Street Address

Street Address Line 2

CityState

Zip Code
Secondary Address

Street Address

Street Address Line 2

CityState

Zip Code
Membership Rules
- Membership is on a yearly basis and members are invited to rejoin on a yearly basis at the discretion of the Chapter President.
- Annual dues are assessed each year. ($80.00 per person)
- Formal dress (Black Tie) is required for the club's formal dinner events.
- Members should not miss two consecutive formal events, unless excused at the discretion of the Chapter President.
- Members will conduct themselves with decorum, reflecting professionalism and gentlemanly behavior.
- All members are expected to participate on a Host Committee when called upon to do so.
Membership acknowledgement*

I/We have read, understood, and accepted the rules for membership.
Optional inclusion in BTCI Phone book
We fully understand and respect that privacy is a top concern, especially given the nature of our group. Participation is entirely voluntary, and your information will be used only for social purposes within our group. It will never be shared outside the membership or used for business and other solicitations.
Phone book Release*

YES - please include my/our informationNO - please do not include my/our information
I will pay my membership using the following*

CheckZelleCredit Card (adds 3%)
Membership Fee $
Number of members
Once you submit your application, you will receive payment instructions for your membership dues.

Thank you!
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BLACK TIE CLUB INTERNATIONAL REHOBOTH BEACH-LEWES MEMBERSHIP REGISTRATION

Membership Rules

Optional inclusion in BTCI Phone book