Widows' and Widowers' Privileges

I wish to apply for signing privileges as a widow of a member. I authorize you to charge annual dues and all usage fees for these privileges to my house account. I assume full responsibility for the payment of these charges. The annual fee for this privilege is 50% of the annual dues for the applicable category in effect from time to time.


Your Information

Your Name (required)

Address Line 1 (required)

Address Line 2

Phone (required)

Deceased Member's Audit Number (not required)

Email Address (required)

Deceased Member's Name (required)

Deceased Member's Class (required)

Date of Death (required)

Example format: yyyy-mm-dd or 2016-01-21




Human Verification