I hereby apply for membership, and authorize The Penn Club of New York to make any necessary inquiries on the information listed on this application as well as to the University of Penns
Trang 1MEMBERSHIP APPLICATION
Dr Mr Mrs Ms APPLICANT’S FULL NAME FULL NAME WHEN ENROLLED(if different from above)
AFFILIATION* _ SCHOOL YEAR
(1st Penn degree, if multiple)
PROGRAM(check all that apply): Full-Time Part-Time Degree Certificate
*Alumnus; Current Student; Faculty/Staff/Board or Committee Member of Penn; Parent; Grandparent; Brother, Sister; or Child of
Alumnus; Executive Education Student If applying as Family Member of Alum, list alumnus name, class year and relationship above.
E MPLOYMENT /P ROFESSIONAL I NFORMATION :(all information required)
Firm/Employer: _ Title: _ Address: _ City, State, Zip: _ Business Phone: _( _ ) Business Fax: _( _ )
P ERSONAL I NFORMATION :(all information required)
Address: _ City, State, Zip: _ Home Phone: _( _ ) Home Fax: ( ) _ Email: Cell Phone: ( ) _ Marital Status: Single Married Please send all correspondence to: Business Home
Date of Birth: / / Social Security Number: - -
C LUB I NFORMATION :
Were you previously a member of the Penn Club? No Yes, from _ to _ Member # _
Did a member refer you? No Yes, by (whom)
S POUSE M EMBERSHIP :
If you wish to receive a separate spouse membership, please complete the following section
Dr Mr Mrs Ms FULL NAME _
Date of Birth: / / Social Security Number: - -
Daytime Telephone: _( _ ) _ Wedding Anniversary: / /
Email: Cell Phone: ( ) _
P ALESTRA F ITNESS C ENTER M EMBERSHIPFor an additional yearly fee, members may add the Palestra Fitness Center to their
account New members of the Palestra are provided three (3) complimentary Fitness Evaluation/Personal Training Sessions Palestra dues are billed quarterly based on a yearly contract, and charged to your house account upon entrance to The Penn Club.
Yes, I will join the Palestra Fitness Center Upon entry, charge the account for: myself my spouse
P AYMENT I NFORMATION
(Payment must be submitted with application CREDIT CARD information REQUIRED even if paying by check.)
American Express MasterCard VISA Check No Amount $ _
Applicant/Cardholder Name (required) Credit Card Number (required) Exp Date /
All payments for membership must include 8.875% New York State Sales Tax added to both dues and initiation fees Dues will be
pro-rated according to our fiscal year beginning July 1 st to June 30 th Please make checks payable toThe Penn Club Valid credit card number
must be provided for processing and verification of application Membership is non-refundable and non-transferable Please allow two
weeks for processing of application Application must be completed IN FULL WITH PAYMENT to be processed.
I hereby apply for membership, and authorize The Penn Club of New York to make any necessary inquiries on the information listed on this application as well as to the University of Pennsylvania and/or any other educational institution to evaluate my application.
If elected into membership, I agree to support and abide by the by-laws and house rules as set forth by The Penn Club of New York I autho-rize The Penn Club of New York to charge my credit card on file for payment of house charges that are 90 days past due, including any applicable finance fees.
Applicant/Cardholder Signature (required) Date / / The Penn Club • 30 West 44th Street • New York, NY 10036 • Phone (212) 403-6627 • Fax (212) 403-6616 • membership@pennclub.org
DM351209
Member Application 12-09.qxd:Member Application 10-08.qxd 12/10/09 12:12 PM Page 1
Referral Code: DMGRD11
Yes, I’d like to participate in the Early Bird Special (offer ends 06/30/11)
Early Bird Special – Apply for membership now and prepay
your 12 months’ dues for July 1st, 2012 to June 30th, 2013 at
2011/2012 rates (before the rate increase) and get free access
to the Penn Club after April 1st, 2012 with no initiation fee
Participating in this Early Bird Special gives you as much as
3 months’ access to the Penn Club that is free of dues!
MEMBERSHIP APPLICATION
Dr Mr Mrs Ms APPLICANT’S FULL NAME FULL NAME WHEN ENROLLED(if different from above)
AFFILIATION* _ SCHOOL YEAR
(1st Penn degree, if multiple)
PROGRAM(check all that apply): Full-Time Part-Time Degree Certificate
*Alumnus; Current Student; Faculty/Staff/Board or Committee Member of Penn; Parent; Grandparent; Brother, Sister; or Child of
Alumnus; Executive Education Student If applying as Family Member of Alum, list alumnus name, class year and relationship above.
E MPLOYMENT /P ROFESSIONAL I NFORMATION :(all information required)
Firm/Employer: _ Title: _ Address: _ City, State, Zip: _ Business Phone: _( _ ) Business Fax: _( _ )
P ERSONAL I NFORMATION :(all information required)
Address: _ City, State, Zip: _ Home Phone: _( _ ) Home Fax: ( ) _ Email: Cell Phone: ( ) _ Marital Status: Single Married Please send all correspondence to: Business Home
Date of Birth: / / Social Security Number: - -
C LUB I NFORMATION :
Were you previously a member of the Penn Club? No Yes, from _ to _ Member # _
Did a member refer you? No Yes, by (whom)
S POUSE M EMBERSHIP :
If you wish to receive a separate spouse membership, please complete the following section
Dr Mr Mrs Ms FULL NAME _
Date of Birth: / / Social Security Number: - -
Daytime Telephone: _( _ ) _ Wedding Anniversary: / /
Email: Cell Phone: ( ) _
P ALESTRA F ITNESS C ENTER M EMBERSHIPFor an additional yearly fee, members may add the Palestra Fitness Center to their
account New members of the Palestra are provided three (3) complimentary Fitness Evaluation/Personal Training Sessions Palestra dues are billed quarterly based on a yearly contract, and charged to your house account upon entrance to The Penn Club.
Yes, I will join the Palestra Fitness Center Upon entry, charge the account for: myself my spouse
P AYMENT I NFORMATION
(Payment must be submitted with application CREDIT CARD information REQUIRED even if paying by check.)
American Express MasterCard VISA Check No Amount $ _
Applicant/Cardholder Name (required) Credit Card Number (required) Exp Date /
All payments for membership must include 8.875% New York State Sales Tax added to both dues and initiation fees Dues will be
pro-rated according to our fiscal year beginning July 1 st to June 30 th Please make checks payable toThe Penn Club Valid credit card number
must be provided for processing and verification of application Membership is non-refundable and non-transferable Please allow two
weeks for processing of application Application must be completed IN FULL WITH PAYMENT to be processed.
I hereby apply for membership, and authorize The Penn Club of New York to make any necessary inquiries on the information listed on this application as well as to the University of Pennsylvania and/or any other educational institution to evaluate my application.
If elected into membership, I agree to support and abide by the by-laws and house rules as set forth by The Penn Club of New York I autho-rize The Penn Club of New York to charge my credit card on file for payment of house charges that are 90 days past due, including any applicable finance fees.
Applicant/Cardholder Signature (required) Date / / The Penn Club • 30 West 44th Street • New York, NY 10036 • Phone (212) 403-6627 • Fax (212) 403-6616 • membership@pennclub.org
DM351209
Member Application 12-09.qxd:Member Application 10-08.qxd 12/10/09 12:12 PM Page 1
Referral Code: DMGRD11
Yes, I’d like to participate in the Early Bird Special (offer ends 06/30/11)
Early Bird Special – Apply for membership now and prepay
your 12 months’ dues for July 1st, 2012 to June 30th, 2013 at
2011/2012 rates (before the rate increase) and get free access
to the Penn Club after April 1st, 2012 with no initiation fee
Participating in this Early Bird Special gives you as much as
3 months’ access to the Penn Club that is free of dues!
two (2)
I authorize The Penn Club to automatically bill my credit card for membership dues on a yearly basis
Introductory Offer - Suburban rates apply immediately
for non-NYC new members joining in 2015.
Brandeis University; Bryn Mawr College; Deerfield Academy; Franklin & Marshall; Gettysburg College; Haverford College; INSEAD;
Johns Hopkins University; London Business School; Peddie School; Swarthmore College; Trinity College; Univ of Chicago; University of Richmond;
Vanderbilt University, Canadian Association of NY*; Chemists’ Club, M.I.T Club*; Vassar Club* (*must have an active membership with these clubs)
*Club#: _
AFFILIATE MEMBERSHIP APPLICATION
Trang 2THE GIFT OF MEMBERSHIP
If you are purchasing this membership as a gift, please fill out the following information:
Gift Giver’s Name:
Gift Giver’s Telephone:
Gift Giver’s Email:
Gift Recipient’s Name:
If you check “Yes”, the new member welcome packet can be mailed to you so that you can present it to the gift recipient as a surprise gift
2 Would you like The Penn Club to mail the New Member Welcome Membership Package to the gift giver or the gift recipient?
Gift Giver/ Parent/Spouse Gift Recipient (address listed on the application)
Please mail the Membership Package to my attention at the following address:
Attn:
Mailing Address:
City, State, Zip:
3 Would you like us to enclose a Membership Certificate on your behalf? Yes No
If yes, please include the following note on the personalized Membership Certificate:
Message: (100 characters)
4 To facilitate your payment, complete the credit card payment information below and sign at the bottom The gift recipient will receive a membership verification form on which s/he will provide their own credit card information and signature for our files Once the new member comes into the clubhouse as a member, s/he can opt to add the Palestra Fitness Center membership at that time
PAYMENT INFORMATION (Payment must be submitted with application CREDIT CARD information REQUIRED even if paying by check.)
American Express MasterCard VISA Check (Number and Amount)
I authorize The Penn Club to automatically bill my credit card for membership dues on a yearly basis
All payments for membership must include 8.875% New York State Sales Tax added to both dues and initiation fees Dues will be
pro-rated according to our fiscal year beginning July 1 st to June 30 th Please make checks payable to The Penn Club Valid credit card
number must be provided for processing and verification of application Membership is non-refundable and non-transferable Please
allow two weeks for processing of application Application must be completed IN FULL WITH PAYMENT to be processed
I hereby apply for membership on behalf of the gift recipient, and authorize The Penn Club of New York to make any necessary inquiries on the information listed on this application as well as to the University of Pennsylvania and/or any other educational institution to evaluate the application I understand that the member for whom I am gifting this membership must submit their own valid credit card and signature and any missing information for our files within 30 days
or the membership may be suspended without refund In the interim, I authorize The Penn Club of New York to charge my credit card on file for payment of house charges that are 90 days past due, including any applicable finance fees, should the member fail to submit this information in a timely basis
Trang 3THE PENN CLUB OF NEW YORK
AFFILIATE MEMBERSHIP
ANNUAL DUES RATES AND INITIATION FEES Fiscal Year July 1, 2015 – June 30, 2016 Age Category
21-28 years old
29-34 years old
35+ years old
Annual Dues
$570
$1225
$1650
Initiation Fee
$570
$1225
$1225
Upon attaining 100 dues-paying members from Brandeis University, the following fiscal year, its affiliate members who do not live or work in New York City will be billed the suburban rate:
Age Category Suburban Annual Dues Suburban Initiation Fee
MEMBERSHIP PROCESS
Completing the Application
9 The Club membership year is July 1st
to June 30th Dues will be pro-rated according to the month in which you join Initiation fees are due in full Rates are subject to change
9 Both initiation fees and dues are subject to New York sales tax of 8.875%
9 ALL requested information must be filled out in order to process your
application
9 All checks should be made payable to The Penn Club and to the attention to the
Membership/Admissions Office Credit card payment is accepted
9 Applications may be dropped off at the front desk, mailed, scanned & emailed or faxed
to the attention of the Membership/Admissions Office at (212) 403-6616 If the application is faxed, the original signed application should be mailed to the Membership Office for record keeping
9 Verification of the information on the application will be conducted during the membership acceptance process
9 Annual dues and initiation fees are determined upon thorough review of the information provided Any additional charges that are determined by the membership department must be paid for in advance before the membership process can be completed
9 Please allow two weeks for processing of membership applications
9 Prospective members may not utilize the Club or any of its facilities or reciprocal clubs until notified of acceptance into the Club
9 New members will be notified by mail of their acceptance into the Penn Club.
The Penn Club y 30 West 44 th Street y New York, NY 10036 y Phone (212) 403-6627y Fax (212) 403-6616 y membership@pennclub.org
Trang 4PENN AFFILIATION:
RESIDENT MEMBERS
Live or work in New York City*
Dues Initiation Fee**
SUBURBAN MEMBERS
Live or work 50 miles from NYC*
Dues Initiation Fee
NON-RESIDENT NATIONAL MEMBERS
Live or work in the U.S.A.*
Dues Initiation Fee
INTERNATIONAL MEMBERS
Live or work outside the U.S.A.*
Dues Initiation Fee
Closer of work or home address, including multiple
home or business locations, used to determine geographic
category.
SPECIAL MEMBERSHIP CATEGORIES Penn Full-Time Undergraduate Students aged 21-24
Graduate Students or Undergrad Students aged 25
and over who are enrolled full-time at The University
of Pennsylvania may join with a waiver of the initia-tion fee at Penn affiliainitia-tion dues rate
Faculty and Staff
Full-time staff of the University of Pennsylvania (Penn) including full-time & adjunct professors and
full-time staff of the University of Pennsylvania Health System (UPHS) including residents
Spouse or Life Partner
A member’s spouse or life partner is eligible for full member privileges upon written application by
the primary member
ASSOCIATE & AFFILIATE SCHOOL MEMBERSHIPS
Dues Initiation Fee**
REINSTATEMENT FEES
Previous members of the club who paid a full initia-tion fee will be charged 50% of the current initiainitia-tion
fee plus applicable annual dues before they are re-admitted into the Penn Club Those who have
not paid an initiation fee, e.g Charter Members or
will have to pay the full initiation fee Application for readmission is subject to Membership and
Finance Committee approval
OVERNIGHT ROOM RATES
STANDARD & DELUXE ROOMS
Standard Queen or two Twin Beds $255.00
FOUNDER’S SUITE
EXTRAS:
Guest fee assessed to all rooms occupied
by guests of members.
PALESTRA FITNESS CENTER
Palestra Membership (Annual Contract; Fees Billed Quarterly)
21-28 years $110 quarterly / $440.00 annually
29 and over $125 quarterly / $500.00 annually
Locker and Laundry
MASSAGE THERAPY
PERSONAL TRAINING
(Spinning, Yoga, Pilates, Nutritional Counseling, and Weight-Loss programs also available)
SQUASH COURTS at the Yale Club
** $38.00 minimum (if playing alone)
HOURS OF OPERATION
PALESTRA FITNESS CENTER
SQUASH COURTS at the Yale Club
BUSINESS CENTER
Saturday
Continental Breakfast 7:00 a.m – 11:00 a.m
Sunday & Holidays
Continental Breakfast 7:00 a.m – 11:00 a.m
BENJAMIN FRANKLIN ROOM
Monday through Friday
Complimentary Coffee 10:00 a.m – 11:00 a.m
MEMBERSHIP RATES
Fiscal Year July 1, 2015 to June 30, 2016
Rates, times and services subject to change at any time.
Please visit www.pennclub.org for current rates.
*
**
*
85.00 750
$10.00 7
2
2
0
PRESIDENTS AND PROVOSTS ROOM Monday through Friday (closed during summer)
THE GRILL ROOM Monday through Friday
Rates subject to change based on market conditions.
Initiation fees due in full for all new members; dues are
pro-rated from the month of joining to the end of the fiscal
year All rates are non-negotiable.
$ 700
Initiation fees are expected to match one full year of dues,
increased over time after the 2015-2016 fiscal year.
Sep-Dec Peak surcharge
Wed Dinner Buffet 6:00 p.m – 8:30 p.m
Weekend & Holidays 8:00 a.m – 4:00 p.m
Rev 4/15 Past Penn affiliated members who joined before age 25,
Breakfast (summer only) 7:00 a.m – 10:00 a.m.