Adventure Club Membership Registration
US MAIL FORM - If you prefer to mail in the Registration please go to PDF Files
30 DAY SATISFACTION GUARANTEE - If, within 30 days, you decide the Club is not for you, you will receive a full refund, less the $10 origination fee pp. as explained in the Member Agreement, as well as, any trip/event discounts received as a member.
NO RENEWAL COSTS, EVER........ Membership is just a one time activation fee.
ONE TIME ACTIVATION FEE .. Single $20 Double $35

REQUIRED ITEMS indicated with a RED asterisk * (if Non-Applicable enter NA).


Membership Type * :


Where did you hear about us? * :


Please identify "other" or "member" if chosen above:



FIRST MEMBER INFORMATION

First Name * :

Last Name * :
Gender * :
 Male Female
Smoke? * :
 Smoke Don't Smoke
Birth Place:
Birth Date/Age
for demographics: 		Date: (mm/dd/yy)  Age:
Address * :
(include apt#)
City * :
State/Zip * :
Home Phone * :
Work Phone * :
Cell Phone * :
E-Mail * :
Occupation * :
Company * :
Would you help
on a committee,
event or trip ? 		Event Planning
Event Leader (Oversee event)
Trip Leader (Oversee trip)
Event or Trip Assistant

Event/Trip leading
experience if any:

Event/Trip
suggestions to lead :


MEMBER AND GUEST AGREEMENT: By typing in the signature below, I certify that I understand and agree with the terms of the Member and Guest Agreement. If paying by credit card, specified below, with this typed signature I also authorize Adventure Club/Club Esprit, a d/b/a of Adventure Club, Inc. to charge my MasterCard, VISA or American Express for the amount as indicated below or the full amount of the Membership checked above if no specific amount is filled in.
 Type signature * :
Date * : (mm/dd/yy)

CREDIT CARD PAYMENT INFORMATION
(information transferred by secured server for your protection)

Credit Card Type * : Mastercard Visa American Express

Amount to charge
 if using 2 cards (double memberships)
Cr Card Number *:
Expiration Date * : (mm/yy)
Security Code * :
(3 or 4 digits)		 Examples of code

Your Credit Card Billing Address if different than above:


Optional Comments:


If you are a Single registrant please submit now.
If you are a Double registrant please continue to the next section.



If the form is successful you will receive a "Confirmation" Screen.





SKIP THIS SECTION UNLESS "DOUBLE MEMBERSHIP"

SECOND MEMBER INFORMATION

First Name * :

Last Name * :
Gender * :
 Male Female
Smoke? * :
 Smoke Don't Smoke
Birth Place:
Birth Date/Age
for demographics: 		Date: (mm/dd/yy)  Age:
Address:
(include apt#)
City:
State/Zip:
Home Phone:
Work Phone:
Cell Phone:
E-Mail:
Occupation:
Company:
Would you help
on a committee,
event or trip ? 		Event Planning
Event Leader (Oversee event)
Trip Leader (Oversee trip)
Event or Trip Assistant

Event/Trip leading
experience if any:

Event/Trip
suggestions to lead :


MEMBER AND GUEST AGREEMENT: By typing in the signature below, I certify that I understand and agree with the terms of the Member and Guest Agreement. If paying by credit card, specified below, with this typed signature I also authorize Adventure Club/Club Esprit, a d/b/a of Adventure Club, Inc. to charge my MasterCard, VISA or American Express for the amount as indicated below or the full amount of the Membership checked above if no specific amount is filled in.
 Type signature:
Date: (mm/dd/yy)

CREDIT CARD PAYMENT INFORMATION IF USING TWO CARDS
(information transferred by secured server for your protection)

Credit Card Type : Mastercard Visa American Express

Amount to charge
 if split between 2 cards (for couples)
Credit Card Number
Expiration Date: (mm/yy)
Security Code
3 or 4 digits : 		Examples of code

Your Credit Card Billing Address if different than above:

Optional Comments:




If the form is successful you will receive a "Confirmation" Screen.


revised 03/22/11