Membership Application – The La Crosse Club

La Crosse Club Member Application

Membership Type

Additional Designees may be submitted for a Corporate Membership after registration.

Individual Membership (Putnam Founder’s Membership)

Scholar & Residency Membership (21 years+)

Corporate Membership

Applicant Sponsored By(Required)

Current La Crosse Club member sponsoring this application.

Applicant Name(Required)

First Last

Signed(Required)

I hereby apply for a membership to The La Crosse Club. If my application is accepted, I agree to pay the regular dues, the assessments required, and any authorized charges to my account when due. I further agree to comply with the provisions of the by-laws and house rules of The La Crosse Club.

I agree

Business or Profession(Required)

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Applicant Phone(Required)

Applicant Email(Required)

Newsletter Consent

I wish to sign up for the electronic newsletter

I agree

Opt-In to Receive Paperless Invoices

I wish to receive invoices via email. (No paper invoices)

I agree

Spouse/Partner (if applicable)

First Last

Spouse Phone

Spouse Email

Name

This field is for validation purposes and should be left unchanged.