CITY CLUB OF BUCKHEAD MEMBERSHIP APPLICATION
CONFIDENTIAL APPLICATION FOR MEMBERSHIP
Invitations to membership are extended without regard to race, creed, color, sex, national origin, age or religion.
I A m A pplying F or:
FULL RESIDENT | AGES 36 AND OVER | $130
YOUNG EXECUTIVE | AGES 30 TO 35 | $105
ASSOCIATE | AGES 21 TO 29 | $80
NON-RESIDENT | LIVE AND WORK OUTSIDE A 75-MILE RADIUS OF ATLANTA | $85
I Would L ike to A dd The F ollowing to M y M embership:
WORLD TRADE CENTER ATLANTA | $15 PER MONTH SPOUSE ATHLETIC CLUB ADD-ON | $29 PER MONTH
WINE CLUB | $20 PER PERSON PER MONTH OR $30 PER COUPLE PER MONTH
NATIONAL ALLIANCE OF PRIVATE CLUBS | $40 PER MONTH
Name: ________________________________________________________________________________ Date: _______________
City Club of Buckhead Sponsor: _______________________________________________________________________________
Personal Information:
Member’s Birthday (M/D/Y): ______________ Instagram @: _________________________ Twitter @: _____________________
Spouse’s Name: _______________________________________________ Spouse’s Birthday (M/D/Y): _____________________
Spouse’s E-mail:_______________________________________ Date of Wedding Anniversary (M/D/Y): _________________
(if wants weekly newsletter)
Child’s Name: _________________________________________________ Child’s Birthday (M/D/Y): ______________________
Child’s Name: _________________________________________________ Child’s Birthday (M/D/Y): ______________________
Permanent Residence:
Home Address:_______________________________________________________________________________________________
City:________________________________ State: ________________ Zip Code:____________ Resident Since: ___________
Home Telephone:_______________________________________ Cell Phone: _________________________________________
Personal E-mail: ______________________________________________________________________________________________
Previous Residence*: _________________________________________________________________________________________
(if resided at current address less than one year)
Endorsements:
1. Personal | Name: _____________________________________________________________________________________
Address: ______________________________________________________________________________________________
Telephone Number: ____________________________ E-mail: _______________________________________________
Relationship/How many years you have known them: _________________________________________________
2. Professional | Name: _________________________________________________________________________________
Address: ______________________________________________________________________________________________
Telephone Number: ____________________________ E-mail: _______________________________________________
Relationship/How many years you have known them: ___________________________________________________
Business Information:
Name of Firm, Corporation or Partnership: _____________________________________________________________________
Position or Title: _______________________________________________________________________________________________
Business Address: _____________________________________________________________________________________________
City: __________________________________________________ State: ________________________ Zip Code: _____________
Business Telephone Number: _________________________________ Business Fax Number: ___________________________
Business E-mail Address: ______________________________________________________________________________________
My Secretary/ Meeting Planner’s Name: _______________________________________________________________________
Nature of Business or Profession: _______________________________________________________________________________
How Long Have You Been At Your Present Position? ____________________________________________________________
Clubs, Societies, and Associations in Which You Hold Memberships: _____________________________________________
______________________________________________________________________________________________________________
College or University Attended: _______________________________________________________________________________
Please Send Weekly E-Newsletter And All Other Online Communications To My:
Personal E-mail Address
Business E-mail Address
Please Direct My Monthly Statement To My: Personal E-mail Address
Business E-mail Address
Please Direct My Official Correspondence To My: Please Bill My Dues:
Monthly
Home Address
Business Address
Annually
(Members Who Pay Dues Annually Receive a Ten Percent (10%) Discount)
Billing Information:
My Membership Will Be Owned By: Myself As An Individual
My Company*
*The Corporate Guarantee below must be completed if the membership is to be owned by your company.
I agree to have all dues and charges billed to my credit card on the 15th of the month.
I would prefer to send a check payment or pay via CCB Website for all dues and charges by the 15th of
the month. In the event I do not pay my statement in full before the 15th of the month, I agree for the credit
card listed below to be charged the full amount by City Club of Buckhead on the 15th of the month.
Signature: __________________________________________________________________________ Date: __________________
Social Security Number: ______________________________________________________________________________________
Credit Card Number: ________________________________________________________ Expiration Date: ________________
Billing Address: _______________________________________________________________________________________________
City, State and Zip Code: _______________________________________________________ CVC Code: _________________
Name As It Appears On Credit Card: __________________________________________________________________________
Accompanying This Application Is My Full Initiation Fee In The Amount Of $_______________________________
Accompanying This Application Is My Corporate Transfer Fee In The Amount Of $_________________________
A 2.5% convenience fee will be added to your member account if your credit card is declined when processed.
Corporate Guarantee:
______________________________________________________________________________is applying for membership as a
Presiding or Additional Member of City Club of Buckhead designated by the undersigned corporation or
partnership. In accordance with the requirements of City Club of Buckhead, the undersigned entity hereby
unconditionally guarantees the prompt payment of all sums due and payable to City Club of Buckhead by its
Designated Member for initiation fees, dues, and all other charges.
The undersigned entity further acknowledges that in accordance with the Bylaws of City Club of Buckhead,
the right to designate additional members may not be transferred from the entity to another individual or
entity. However, in the event of a transfer or resignation of a Presiding or additional Member, a successor
may be nominated by the entity upon application and payment to City Club of Buckhead of the then current
transfer fee.
The undersigned entity hereby authorizes the Club, by and through it authorized agents, to investigate its credit standing for those members who do not choose to pay by credit card. In witness whereof, the
undersigned entity, through its duly authorized officer or partner has hereunto set its hand and
seal this _______ day of ___________________________ , ___________.
Name of Corporation: ________________________________________________________________________________________
By: ___________________________________________________________________________________________________________
Title: _________________________________________________________________________________________________________
NO ASSESSMENTS
I understand that I can never be assessed as a matter of contract with the Club and that it is further distinctly understood and
agreed that I am assuming no liabilities whatsoever in connection with the membership other than the payment of sum set out
above, applicable membership dues and charges incurred by me, my family, and guests in the use of the Club, and that such
membership dues not confer upon me any ownership of the Club property or its assets.
MEMBERSHIP COMMUNICATIONS
I grant the club permission to send club-related informational and marketing material to me through email. I understand that the
club will not share my information with any other entity. _______________
Initial
USE OF LIKENESS
Photos of Members and their Guests are taken at club functions from time to time and may be used occasionally in newsletters, club
displays, or on the Member’s Log In area of the club’s website. As a Club Member I acknowledge this policy and give my permission
to be included at club management’s discretion. ________________
Initial
REFUND OF INITIATION FEES
It is agreed that the initiation fee enclosed herewith shall be refunded to me only if my application for membership is refused. It is
understood that if my application is accepted, the initiation fee shall be deemed fully earned and non-refundable.
RESIGNATIONS
Any Member of the Club may resign from membership by giving thirty (30) days written notice to the Membership Department.
Such resignations will not relieve the Member of payment of indebtedness to the Club, including dues for the month in which the
resignation was received. The resignation shall not be effective until all Club dues and charges are paid in full. ________________
Initial
ATHLETIC LIABILITY WAIVER
Each member with a Resident or Athletic Only membership acknowledges by acceptance of his or her membership that use of the
Athletic facilities, including, without limitation, exercise and weight equipment, swimming pool, sauna, steam, whirlpool facilities as
well as participation in any and all classes or sports can be hazardous and may result in personal injury. The management of the
club recommends that all members and guests obtain the advice of medical professionals before engaging in such activities. The
club also recommends that all members use any and all equipment properly and in strict accordance with the rules, regulations,
and instructions applicable. If members have any questions regarding the proper use of the equipment, trained staff members are
available to answer questions and provide instruction.
It is expressly agreed that any exercise or use of the club or club facilities, without limitation, shall be undertaken at the members
own risk. The member represents that he or she is physically able to participate in any and all activities offered by the club and
agrees that the club takes no responsibility for determining members ability to partake in said activities. City Club of Buckhead and
its agents and employees shall not be liable for any claims, demands, actions, or causes of action for any member or for any injuries
or damages to property arising out of or resulting from the use of any facility or services of City Club of Buckhead. Member does
hereby expressly forever release and discharge City Club of Buckhead, and all affiliated individuals and entities from such claims,
demands, action, except for negligence or willful misconduct on the part of City Club of Buckhead and its agents or employees.
I understand and acknowledge that the current operator of the City Club of Buckhead may be replaced by or with the approval of
the owner thereof and of the Building in which the City Club of Buckhead is located without notice to, or approval of, me and that
the terms of this agreement will continue in full force and effect notwithstanding such change. ________________
Initial
INFORMATION ABOUT PROSPECTIVE MEMBERS
I hereby authorize the Club, by and through its authorized agents, to request and obtain consumer reports which may investigate my
credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, and to obtain, through
personal interviews with neighbors, friends, associates, or mode of living so that the Club may determine, in its sole discretion, my
suitability and compatibility as a prospective member of the Club. I understand that I may, within a reasonable period of time after
the date of this application, submit a written request to be informed of the nature and scope of the investigative consumer report
conducted by the Club and the Club will disclose this information to me within five (5) days after the date on which such request for
disclosure was received by the Club. I understand that membership may be denied for any reason whatsoever, or without reason,
in the sole discretion of the Club. However, I also understand that, as a matter of policy, the Club will not approve or disapprove
an application for membership based on race, creed, color, disability, religion, sex, or national origin. I understand that if my
application for membership is denied and if that denial of membership is based in whole or in part on any information contained in
a consumer report, I will be provided with: (1) notice of the denial of my application for membership; (2) the name, address, and
telephone number of the reporting agency that furnished the Club with the consumer report; (3) a statement that the reporting
agency did not make the decision to deny my application for membership and that the reporting agency is unable to provide me
with the reasons why my application was denied. I understand that if my application for membership is denied based in whole or in
part on any information contained in a consumer report that I am entitled: (1) to obtain a free copy of a consumer report from the
consumer reporting agency within sixty (60) days of my receipt of notice of the denial of my application for membership; and (2) to
dispute with the credit reporting agency the accuracy or completeness of any information in a consumer report furnished by the
agency.
I acknowledge that I am individually liable for dues and charges incurred under this membership. If this is a corporate membership, I
acknowledge that I am jointly and severally liable for those dues and charges. If accepted to membership, I agree to abide by the
Bylaws of City Club of Buckhead, as they may be amended from time to time.
Signature: _________________________________________________________________________________________ Date: ______________________
Admission Committee Approval Granted this _________ day of ____________________________________________________________________