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TO APPLY FOR 12, PLEASE COMPLETE THE FORM BELOW AND SUBMIT IT FOR REVIEW BY THE BOARD.

 

I hereby apply for membership of 12 Social. If accepted, I agree to be bound by the House Rules.

This form will take around ten minutes. If the form is not completed in full, it will not retain your information. Any application missing information will be deemed incomplete and not considered.

This form is SECURE and all information shall be treated in confidence.

Initiation Fee and Annual Dues of $2000 are due the first year of membership. Every subsequent year, member will pay an Annual Due of $2000.

Payment will be processed upon notification of acceptance into 12 at RFD Social. Membership is a full, one-year term.

Membership term begins upon notification of acceptance.

 

Contact Information

Name *
Name
Phone *
Phone
Date of Birth *
Date of Birth
Enter your complete address.

Employment Information

Work Phone *
Work Phone

Personal and Professional References

Personal Interests

Business, entertaining clients, or social?
Tell us about your hobbies and interests.

Background Information

Have you been convicted of a felony, released from prison in the past 7 years, or been convicted of an offense that might make you unsuitable for membership? (NOTE: A "Yes” answer does not automatically disqualify you from membership. The nature and date of the offense will be considered.) *
Are you currently a member of another club or organization? *

Understanding, Certifcation and Acceptance of Application

I understand that upon acceptance, my credit card will be charged the initial Membership Dues for a full one-year term. If accepted, I agree to be bound by the House Rules. *

Payment Information

Name on Credit Card *
Name on Credit Card
3 or 4 Digit Security Code