Coat Room Lounge Application

You are one step closer to joining a select group of discerning individuals looking to enjoy the finest Whiskey, bourbon, Cigars, and Champagne available in the privacy of a members-only club.

Referred By:

Name of member or staff who invited you to apply?

First Name*

Last Name*

Spouses First Name

Spouses name if appicable

Street Number*

Street Name*

City*

State*

Zip Code*

Phone Number*

Phone

Email Address*

Type of Membership*

Private Gold $22 a month Private Platinum $35 a month Corporate Gold $120 a month Corporate Platimun $139 month

Select or enter value

Employers Name*

Occupation*

Members Gross Annual Income*

How many times a week do you dine out?*

Select

Your favorite Cigar?

Your favorite Bourbon or Whiskey?

Your favorite Champagne?

Send me a copy of my responses

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