Member Application 12-09.qxd:Member Application 10-08.qxd 12/10/09 12:12 PM Page 1

Member Application 12-09.qxd:Member Application 10-08.qxd 12/10/09 12:12 PM Page 1

EarlyIntroductory Bird Special Offer –- ApplySuburban for membership rates apply immediatelynow and prepay Referral Code:DM351209 DMGRD11 yourfor non-NYC 12 months’ new dues members for July joining 1st, 201 in 22015. to June 30th, 2013 at 201Early1/201 Bird2 Specialrates (before – Apply the for rate membership increase) and now get and free prepay access  Yes,Referral I’d like Code:to DM351209participate DMGRD11 in toyour the 12 Penn months’ Club dues after forApril July 1st, 1st, 201 2012 with2 to noJune initiation 30th, 201fee.3 at Participating2011/2012 rates in this (before Early theBird rate Special increase) gives and you get as freemuch access as  Yes, I’d the like Early to participate Bird Special in 3to months’ the Penn access Club afterto the April Penn 1st, Club 201 that2 with is freeno initiation of dues! fee. (offer ends 06/30/11) Participating in this Early Bird Special gives you as much as the Early Bird Special 3 months’ access to the Penn Club that is free of dues!AFFILIATEMEMBERSHIP MEMBERSHIP APPLICATION APPLICATION (offer ends 06/30/11) Dr. Mr. Mrs. Ms. APPLICANT’SMEMBERSHIP FULL NAME ______APPLICATION

FULLDr. NAMEMr. WHENMrs. ENROLLED Ms. APPLICANT’S(if different from above) FULL______NAME ______AFFILIATION*FULL NAME WHEN______ENROLLED (if different from above) ______SCHOOL______YEAR______(1st Penn degree, if multiple) AFFILIATION*Brandeis Univ.; Bryn______Mawr College; Deerfield Academy; Franklin & SCHOOLMarshall; Gettysburg______College; ;YEAR INSEAD;______PROGRAMJohns Hopkins Univ.;(check London all that apply)Business: School;Full-Time Peddie School; Part-Time ;Degree Trinity College;Certificate Univ. of Chicago; Univ.(1 ofst Penn Richmond; degree, if multiple) *Alumnus; Current Student; Faculty/Staff/Board or Committee Member of Penn; Parent; Grandparent; Brother, Sister; or Child of PROGRAMUniv. of Vermont;(check Vanderbilt all that apply)Univ.;: Canadian Full-Time Association ofPart-Time NY*; Chemists’ Club,Degree M.I.T. Club*; Certificate Vassar Club* (*MustAlumnus; haveExecutive an active membershipEducation with Student. these If clubs) applying as Family Member of Alum, list alumnus name, class year and*Club relationship #:______above. *Alumnus; Current Student; Faculty/Staff/Board or Committee Member of Penn; Parent; Grandparent; Brother, Sister; or Child of Alumnus; Executive Education Student. If applying as Family Member of Alum, list alumnus name, class year and relationship above. EMPLOYMENT/PROFESSIONAL INFORMATION: (all information required) EFirm/Employer:MPLOYMENT/PROFESSIONAL ______INFORMATION: (all information required) Title: ______Firm/Employer:Address: ______Title: ______Address:City, State, ______Zip: ______City,Business State, Phone:Zip: _____(______)______Business Fax:_____( ______)______BusinessPERSONAL Phone:INFORMATION _____(: (all ______information )______required) Business Fax:_____( ______)______Address:PERSONAL I ______NFORMATION: (all information required) Address:City, State, ______Zip: ______City,Home State, Phone: Zip:_____( ______)______Home Fax: ____(______)______Email:Home ______Phone: _____( ______)______HomeCell Phone: Fax: ____(______)______MaritalEmail: ______Status: Single Married Please send all correspondence Cell Phone: ____(______)______to: Business Home MaritalDate of Status: Birth: ______Single /______Married /______Please send Social all Security correspondence Number: to: ______-______-______Business Home Date of Birth: ______/______/______Social Security Number: ______-______-______CLUB INFORMATION: CWereLUB youINFORMATION previously: a member of the Penn Club? No Yes, from ______to ______Member # ______WereDid a you member previously refer you? a member No of theYes Penn, by Club? (whom) No______Yes, from ______to ______Member # ______SDidPOUSE a memberMEMBERSHIP refer you?: No Yes, by (whom) ______IfSPOUSE you wishMEMBERSHIP to receive: a separate spouse membership, please complete the following section If youDr. wish Mr. to receiveMrs. a separateMs. FULL spouse NAME membership,______please complete the following section Date Dr. of BirtMr.h: ______Mrs. /______Ms. FULL /______NAME ______Social Security Number: ______-______-______DaytimeDate of Birt Telephone:h: ______( /______/______)______Social Security Wedding Number: Anniversary: ______-______-______/______/______Email:Daytime ______Telephone: _____( ______)______Wedding Cell Phone: Anniversary: ____(______)______/______/______PEmail:ALESTRA ______FITNESS CENTER MEMBERSHIP For an additional yearly fee, Cell members Phone: ____(______)______may add the Fitness Center to their account. New members of the Palestra are provided threetwo (2) (3) complimentary Fitness Evaluation/Personal Training Sessions. Palestra PALESTRA FITNESS CENTER MEMBERSHIP For an additional yearly fee, members may add the Palestra Fitness Center to their dues are billed quarterly based on a yearly contract, and charged to your house account upon entrance to The Penn Club. account. New members of the Palestra are provided three (3) complimentary Fitness Evaluation/Personal Training Sessions. Palestra duesYes, are I billed will join quarterly the Palestra based on Fitness a yearly Center. contract, Upon and entry,charged charge to your the house account account for: upon myself entrance tomy The spouse Penn Club.

Yes, I will join the Palestra Fitness Center. UponPAYMENT entry, chargeINFORMATION the account for: myself my spouse (Payment must be submitted with application. CREDIT CARD information REQUIRED even if paying by check.) PAYMENT INFORMATION (PaymentAmerican must Express be submitted MasterCard with application. VISA CREDIT Check CARD No. information ______REQUIRED Amount even $______if paying by check.) Applicant/CardholderAmerican Express Name MasterCard(required) ______VISA Check No. ______Amount $______CreditApplicant/Cardholder Card Number Name(required)(required)______Exp. Date ______/______All payments for membership must include 8.875% New York State Sales Tax added to both dues and initiation fees. Dues will be pro- I authorize The Penn(required) Club to automatically bill my credit card for membership dues on a yearly basis Creditrated according Card Number to our fiscal year beginning______July 1st to June 30th. Please make checks payable to The Exp. Penn Date Club.______Valid credit card /______number mustAll payments be provided for membership for processing must and include verification8.875% ofNew application. York State Membership Sales Tax addedis non-refundable to both dues and and non-transferable. initiation fees. Dues Please will allow be pro- two weeksrated according for processing to our of fiscal application. year beginningApplication July 1st mustto June be completed 30th. Please IN make FULL checks WITH payable PAYMENT to The to be Penn processed. Club. Valid credit card number mustI hereby be apply provided for membership, for processing and and authorize verification The Penn of application. Club of New Membership York to make is anynon-refundable necessary inquiries and non-transferable. on the information Please listed allow on two this weeksapplication for pr asocessing well asof application. to the UniversityApplication of Pennsylvania must be completed and/or INany FULL other WITH educational PAYMENT institution to be processed. to evaluate my application. IIf hereby elected apply into membership, for membership, I agree and to authorize support and The abide Penn byClub the of by-laws New York and to house make rules any necessary as set forth inquiries by The Penn on the Club information of New York. listedI autho-on this rizeapplication The Penn asClub well of as New to York the to University charge my of credit Pennsylvania card on file and/or for payment any other of house educational charges that institution are 90 daysto evaluate past due, my including application. any applicableIf elected into finance membership, fees. I agree to support and abide by the by-laws and house rules as set forth by The Penn Club of New York. I autho- rize The Penn Club of New York to charge my credit card on file for payment of house charges that are 90 days past due, including any Applicant/Cardholderapplicable finance fees. Signature (required) ______Date ______/______/______Applicant/CardholderThe Penn Club • 30 West 44th Signature Street • New(required) York, NY______10036 • Phone (212) 403-6627 • Fax Date (212) 403-6616 ______• [email protected] /______/______The Penn Club • 30 West 44th Street • New York, NY 10036 • Phone (212) 403-6627 • Fax (212) 403-6616 • [email protected]

THE PENN CLUB OF NEW YORK AFFILIATE MEMBERSHIP

ANNUAL DUES RATES AND INITIATION FEES Fiscal Year July 1, 2015 – June 30, 2016

Age Category Annual Dues Initiation Fee 21-28 years old $570 $570 29-34 years old $1225 $1225 35+ years old $1650 $1225

Spouse Membership $365 N/A

Upon attaining 100 dues-paying members from , the following fiscal year, its affiliate members who do not live or work in will be billed the suburban rate:

Age Category Suburban Annual Dues Suburban Initiation Fee 21-28 years old $390 $390 29-34 years old $850 $850 35+ years old $1130 $1130

MEMBERSHIP PROCESS

Completing the Application 9 The Club membership year is July 1st to June 30th. Dues will be pro-rated according to the month in which you join. Initiation fees are due in full. Rates are subject to change. 9 Both initiation fees and dues are subject to New York sales tax of 8.875%. 9 ALL requested information must be filled out in order to process your application. 9 All checks should be made payable to The Penn Club and to the attention to the Membership/Admissions Office. Credit card payment is accepted. 9 Applications may be dropped off at the front desk, mailed, scanned & emailed or faxed to the attention of the Membership/Admissions Office at (212) 403-6616. If the application is faxed, the original signed application should be mailed to the Membership Office for record keeping. 9 Verification of the information on the application will be conducted during the membership acceptance process. 9 Annual dues and initiation fees are determined upon thorough review of the information provided. Any additional charges that are determined by the membership department must be paid for in advance before the membership process can be completed. 9 Please allow two weeks for processing of membership applications. 9 Prospective members may not utilize the Club or any of its facilities or reciprocal clubs until notified of acceptance into the Club. 9 New members will be notified by mail of their acceptance into the Penn Club.

The Penn Club y 30 West 44th Street y New York, NY 10036 y Phone (212) 403-6627y Fax (212) 403-6616 y [email protected] OVERNIGHT ROOM RATES SQUASH COURTS at the Yale Club 45 min. courtrental $ 19.00 per player** STANDARD & DELUXE ROOMS Guest Fee$14.00 per player Monday –Sunday per night ** $38.00 minimum (if playing alone) StandardQueen or two Twin Beds $255.00 DeluxeQueen $270.00 HOURS OF OPERATION MEMBERSHIP RATES Standard, King $280.00 Deluxe King $300.00 Fiscal Year July 1, 2015 to June 30, 2016 PALESTRA FITNESS CENTER Monday –Friday 6:30 a.m.– 9:30 p.m. FOUNDER’S SUITE PENN AFFILIATION: SPECIAL MEMBERSHIP CATEGORIES King, Walk-in Closet $400.00 Weekend & Holidays 8:00 a.m. – 4:00 p.m. Penn Full-Time Undergraduate Students aged 21-24 RESIDENT MEMBERS Dues $200.00 SQUASH COURTS at the Yale Club Liveor workinNew York City* EXTRAS: Initiation Fee waived Monday –Friday 6:30 a.m.–9:30 p.m. Dues Initiation Fee** Guest Fee* Up to $100.00 Saturday–Sunday 8:30 a.m.–5:30 p.m. 21-24 years of age $ 330 N/A Graduate Studen