Name *

First Name

Last Name

Mobile Phone *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

By submitting this form I agree to the following: *

YES! I would like to become a Socialites Club member.

I understand that dues are automatically debited on my anniversary date

I may cancel my membership at any time with 30-days notice.

I have read and agree to The Socialites Code of Conduct.

I am ready to spice up my social life and be a part of a spirit-lifting group!

Date of Birth *

MM

DD

YYYY