Form Designer

Application for Signing Privileges

Please fill out the following application for signing privileges and submit to the New Membership office. Only existing members of the Club may fill out this form and request Signing Privileges for their spouse or partner.

The annual fee for signing privileges is 50% of the applicable category in effect (as this is a reduced rate, additional discounted categories such as joint membership, graduation gift membership, faculty membership, or 25-year member rates—do not apply). If you have any questions, please call the New Membership office at 212-827-1207 or email [email protected].

To the House Committee:

I wish to apply for signing privileges for my spouse or domestic partner. My spouse will have a separate account, but I assume full responsibility for the payment of my spouse/domestic partner’s annual dues and all usage fees to my spouse/domestic partner’s house account. I understand that this signing privilege account is contingent upon my account as a full member of HCNY.

Current Member Information

Member Audit Number *

Member First Name *

Member Last Name *

Spouse Information

Spouse Name Prefix *

Spouse First Name *

Spouse Last Name *

Spouse Email (must be different from primary member email) *

Spouse Date of Birth *

Spouse Gender *

Male

Female

Other

Spouse Phone *

Other Amount

Spouse address if different from Member resident address

Street Address

Address Line 2

City

State (abbreviated) / Province / Region

ZIP / Postal Code

Country

Consent

By checking this box, I hereby sign and authorize the Welcoming Committee to make any necessary actions and inquiries to process this application. I also agree to abide by the Club's By-Laws and House Rules if I become a member and to pay when due all Club charges as invoiced to me. *

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Form Designer

Application for Signing Privileges

To the House Committee: