Community-Social Impact Membership Application

CONTACT INFORMATION

Name (Primary Applicant)*

Spouse (If Applicable)

Address*

Cell Phone*

Home/Business Phone

Preferred Email*

Spouse's Phone (If Applicable)

Spouse's Preferred Email (If Applicable)

PERSONAL DETAILS

Marital Status*

Single

Married

Divorced

Widowed

Dependent #1 Name

Age

Dependent #2 Name

Age

Dependent #3 Name

Age

Race

White

Black

Hispanic

Asian

Middle Eastern

Indian

Native American

Other

Date of Birth*

Spouse Date of Birth

PROFESSIONAL DETAILS

Industry*

Occupation/Job Title*

Company Name*

Company Website

Brief Summary of Industry*

Business Address

Business Phone

Have you ever been convicted of a felony?*

Yes

AREAS OF INTEREST

Areas of Interest

QUESTIONNAIRE

How did you hear about The Rook?*

Why do you wish to join The Rook?*

Describe your charity and community involvement over the past three years.*

How will your membership best suit you, your family and your lifestyle?*

Rate your interest in experiencing live music at The Rook (0 - No Interest; 10 - High Interest).*

NOMINATION

Nominations from current Rook Members can sometimes help speed up the process. You can send in letters of nomination via email to info@therookmckinney.com after you have submitted your application.

If you know Rook members, please list their names as references here.

I do not know any Rook members

FINAL STEP

By submitting this application, I hereby apply for membership at The Rook. If elected, I agree to be bound by the The Rook Rules, Policies and Charter and to pay such fees as The Rook Rules shall require. I authorize my information to be used for internal The Rook purposes only.

Upon signing this Prospective Member Application, I authorize the disclosure and release of information requested by The Rook for investigating my background and qualifications for membership, including without limitation, criminal records and public data and shall hold The Rook harmless from all such acts.

I understand that membership in The Rook is by invitation only and to acquire a membership in The Rook, I must be invited for membership. Membership is contingent upon approval by The Rook, which approval shall be at its sole discretion.

By signing below, I hereby acknowledge that I have agreed to the above guidelines.

Full Name*

Initials*

Date*