Belvedere Membership Application

Belvedere Circle Membership Application
Casa Belvedere | The Italian Cultural Foundation
Dining & Hospitality Operated by Belvedere Hospitality Group, LLC
Application for Membership
The undersigned hereby applies for Belvedere Circle Membership at Casa Belvedere, a historic cultural landmark owned and operated by The Italian Cultural Foundation at Casa Belvedere, a New York State not-for-profit organization and IRS-recognized 501(c)(3) public charity.

I acknowledge and understand that all dining services, hospitality operations, and minimum dining requirements associated with Belvedere Circle Membership are operated and administered by Belvedere Hospitality Group, LLC, a separate for-profit entity.

Submission of this application does not guarantee membership. All applications are subject to review and approval by the Board of Governors of The Italian Cultural Foundation at Casa Belvedere. Applications are typically processed within five to seven business days.
PRIMARY MEMBER & SPOUSE / PARTNER INFORMATION
Primary Member*

First NameLast Name
Spouse/Partner*

First NameLast Name
Primary Member Email*
example@example.com
Spouse/Partner Email*
example@example.com
Primary Member Date of Birth

MonthDayYear
Date
Spouse/Partner Date of Birth

MonthDayYear
Date
Primary Member Phone
Please enter a valid phone number.Format: (000) 000-0000.
Spouse/Partner Phone
Please enter a valid phone number.Format: (000) 000-0000.
Primary Member Occupation/Profession
Spouse/Partner Occupation/Profession
Primary Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Belvedere Circle Membership is issued in the name of the Primary Member; however, current contact and professional information for both spouses or partners is required for membership communications, guest privileges, and account administration.
MarriedSingleWidowedDomestic Partner
CHILDREN (Under Age 21)
Please list names and dates of birth
Sponsor/Reference*

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
ACKNOWLEDGMENT & AGREEMENT
By signing this application, I acknowledge that I have received, or have been made available, the Terms and Conditions of Membership and agree to abide by all rules, policies, and bylaws of:

The Italian Cultural Foundation at Casa Belvedere, and Belvedere Hospitality Group, LLC, as applicable and as amended from time to time.

I further understand and agree that:
- Membership is non-transferable
- Membership privileges may be suspended or revoked for failure to comply with club rules or financial obligations
- The initiation donation is refundable only if my application is not approved by the Board of Governors
- Approved initiation donations are non-refundable
- All information provided shall remain strictly confidential
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Belvedere Circle Membership Application

PRIMARY MEMBER & SPOUSE / PARTNER INFORMATION