Home Events Match Maker Membership > Membership Form Contact Us Goodies Testimonials Photo Gallery FAQ		Membership Form   Please fill out this simple membership form to tell us about yourself. Once you become a member, you will be able to join other single professionals for dining, dancing, parties, and other social and cultural events. Name Address City State -- Select -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming     Zip Home Phone Work Phone FAX E-mail Profession Employer City Referred by   Please describe yourself: Gender Male       Female Date of Birth Age Height Weight Marital Status Single       Divorced       Widowed Ages of children   Religious/Ethnic Background (optional)   Hobbies   Describe the qualities of the person you are looking for     SSC offers several memberships. Choose the one which best suits your needs       6 Month Special Fall/Winter Membership Special - $175 (usually $350)     1 Year Fall/Winter Membership Special - $275 (usually 450)   Membership is neither transferrable nor refundable. Memberships maynot be put "on hold".     Please provide the following billing information:   Credit card -- Choose One -- VISA MasterCard Discover Cardholder Name Card Number Expiration Date   This form is not secure. If you do not feel comfortable sending your credit card information over the internet, you can: Charge your membership by calling us at 650.327.4645, or Pay by check by mailing your check and a print-out of this form to Singles Supper Club, 1944 Emerson St, Palo Alto, CA 94301. I understand that the Singles Supper Club/Single Gourmet staff does not screen club members nor guests, and that neither the staff nor the club is to be held responsible for any actions of any person(s) involved with club activities. SSC reserves the right to deny, cancel, or otherwise terminate membership for behavior deemed disruptive to SSC events or dangerous to others or self or other due cause. Membership is non-refundable, non-transferable, and it cannot be put "on hold."         < TOP >

Singles Supper Club PO Box 60518 Palo Alto CA 94306 650.327.4645   ©1999-2001 Singles Supper Club All rights reserved fun@SinglesSupperClub.com   Web production: Beetown.com