Membership Become a member of The Vine Club by filling out the application below Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. Personal Information Full Name *Email Address *Phone Number *Gender * Company utilizing other's Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Device Type *Device TypeAppleAndroidInstagram Profile *Please type N/A if you do not have an account.Which plan are you interested in? *Social Membership ($1500/Year - $425 Quarterly + $895 Initiation)VIP Membership ($3900/Year - $1025 Quarterly + $895 Initiation)Not sure yet – I’d like more informationTell us about yourselfWhat is your relationship status? *SingleMarriedIn a relationshipEngagedDivorcedWidowedIf you have a significant other who will be utilizing your membership, please list their name and phone number below. Significant other's nameSignificant other's phone numberHow many family memberswill be utilizing your membership?How many family members will be utilizing your membership?(Please only include significant other and children) Primary Address Street Address *Street Address Line 2State *SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingCountry *SelectUnited StatesTown/City *Zip Code * Your Work Are you currently employed? If so, please answer the following questions. Company name:Title:Company Tenure: Payment Payment *Initiation Fee Total *Price: $895.00You will receive a full refund of this $895 feeif your application is unsuccessful. Checkboxes *Submit *By submitting this application, you authorize The Vine Club to use the provided information to conduct a background check as part of the membership approval process. While this will not affect your credit rating, we will assess publicly available financial records and other relevant factors to ensure applicants have demonstrated financial responsibility and the ability to consistently portray discretion. Our goal is to maintain the financial and physical safety of our members.Submit
