Application for Membership Vision & Applicant Understanding The National Club is a welcoming community where personal and professional relationship are nurtured, and where innovation, diversity and thought leadership are cultivated. The National Club serves as its members home and office away-from-home. Members come together to share their ideas and opinions on life, business and community. The National Club encourages its members to be active and engaged citizens. Through ongoing networking and social events, members cultivate long-lasting relationships in Canada and, through a network of reciprocal clubs, around the world. The members of The National Club share the following vision and principals: The National Club does not discriminate against any person because of race, colour, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, or domestic partner status. The National Club is a not-for-profit organization that requires the active involvement of all its members. In compliance with the Accessibility for Ontarians with Disabilities Act, The National Club is committed to excellence in serving all members and guests including people with disabilities. I understand and agree Date / / (Month) (Day) (Year) 1
Membership Application Process Complete all areas on the application. Once complete, send your application package to Membership & Communication Coordinator, Donna Hersey at Donna@thenationalclub.com. Applicants are encouraged to attend an orientation to meet with members of the Board of Directors and learn more about the Club. For those who are unable to meet in person, we are happy to coordinate a conference call. Non-resident and overseas applicants must meet and be approved by (whether in person or by conference call) one member of the Board of Directors, and resident applicants are required to meet and be approved by two. The names and business information of the applicants will be printed and posted in the Club at least two weeks prior to the board meeting in which they will be brought forward for approval. The application will be brought to the Board of Directors for approval and the applicant will be informed once their application has been approved. If a waiting list develops, completed applications will be processed in the order in which they are received. 2
303 Bay Street Toronto, Ontario M5H 2R1 416.364.3247 APPLICANT INFORMATION Select the appropriate member category for which you are applying: Resident Non-resident Overseas Honourary BUSINESS OCCUPATION: WORK INFORMATION BUSINESS ADDRESS: CITY: PROVINCE: POSTAL CODE: BUSINESS EMAIL: CELL PHONE: BUSINESS LINE: PERSONAL INFORMATION HOME ADDRESS: CITY: PROVINCE POSTAL CODE: BIRTHDATE: HOME PHONE: EMAIL: PARTNER/SPOUSE INFORMATION EMAIL: OCCUPATION: DD/MM/YYYY PROPOSER SIGNATURE: DIRECTOR APPROVAL SIGNATURE: SIGNATURE: If applicable: have you ever been a member of a private club? Yes No 3
ON-LINE ROSTER AND EMAIL CONTACT INFORMATION PHONE NUMBER: EMAIL ADDRESS: NEWSLETTER AND EVENT OPT-IN By checking this box, you agree to receive newsletters, event information, club announcements and new menus by email. You may unsubscribe at any time. See our privacy policy for more information at thenationalclub.com/privacy. If you wish for your spouse/partner to receive these emails as well, or instead of yourself, please provide their email address: STATEMENT OF ACCOUNT & BUSINESS NOTICES Members may choose to receive the monthly statements and business notices by email or by post. By selecting email, you are agreeing to receive electronic communications from The National Club. Send my member account statement and business notices by email. Preferred email address: ; OR Send me member account statement and business notices by post to my: Business address Home address FEES & METHOD OF PAYMENT Initiation fee: HST: Subtotal Annual dues HST: Subtotal Notes: Payment for membership is required immediately upon approval from the Board of Directors. Please check off your preferred payment option for each category (cheque, credit card or preauthorized debit). Payment refers to entrance fees, annual dues, house account charges and private functions. Cheque Credit Card Debit Special Instructions 4
PAYMENT INFORMATION CREDIT CARD (IF APPLICABLE) Card Type: Card Number: Expiry Date: PAYMENT INFORMATION PRE-AUTHORIZED DEBIT (only applicable for Canadian banking) I/we authorize The National Club., and the financial institution designated (or any other financial institution I/We may authorize at any time) to begin deductions as per my/our instructions for monthly regular recurring payments and/or one-time payments from time to time, for payment of all charges arising under my/our The National Club account(s). Regular monthly payments for the full amount of services delivered will be debited to my/our specified account on or around the 15th day of each month. The National Club will provide 10 days written notice of the amount of each regular debit. The National Club will obtain my/our authorization for any other one-time or sporadic debits. This authority is to remain in effect until The National Club. has received written notification from me/us of its change or termination. This notification must be received at least ten (10) business days before the next debit is scheduled at the address provided below. I/We may obtain a sample cancellation form, or more information on my/our right to cancel a Pre-Authorized Debit (PAD) Agreement at my/our financial institution or by visiting www.cdnpay.ca. The National Club may not assign this authorization, whether directly or indirectly, by operation of law, change of control or otherwise, without providing at least 10 days prior written notice to me/us. I/we have certain recourse rights if any debit does not comply with this agreement. For example, I/we have the right to receive reimbursement for any PAD that is not authorized or is not consistent with this PAD Agreement. To obtain a form for a Reimbursement Claim, or for more information on my/our recourse rights, I/we may contact my/our financial institution or visit www.cdnpay.ca Name(s): Date: The National Club Account Number (will be assigned after approval): Address: City: Province: Postal Code: Phone number (Bus): Phone Number (Res): Financial Institution: Account Number: Transit Number: Authorized signature Date FINAL AUTHORIZATION I understand and agree that The National Club will retain certain necessary member information required for the proper conduct of its affairs and that I may review it any time. I will inform The National Club of any changes to my address, e-mail, or preferences regarding distribution of information to other club members. If The National Club accepts my application for membership, I hereby agree to pay all fees and accounts as they become due and to accept, abide and be governed by the By- Laws and Regulations passed by The Club. Signature of applicant Date 5
MEMBER INTERESTS (optional) The National Club does its best to offer a variety of benefits, services and events to its membership. Please allow us to learn more about you and your partner by selecting the below services and events that you are interested in. M = Member P = Partner Networking Club Events MEMBER INTERESTS GENERAL M P M P Affiliate Clubs Dining at the club Hosting Private Business/Social Events Wine Club Black-tie Wine tastings Cooking classes Cinephile Society Cigar Nights Jazz nights Golf tournaments Oscar Night MEMBER INTERESTS EVENTS M P M P Family holiday brunches Women s Networking Speaker Series Investor s Roundtable Charity events Specialty cuisine nights Robbie Burns Other (please list below) Other interests: 6