Print out this form, fill it out and return it with payment to our hostess on your next visit to Vincent's.

Vincent's V.I.P. Membership Application:
Annual Membership Fee (for two): $250

Please Print:
NAME:________________________________________ ADDRESS:____________________________________

CITY:________________STATE:_____ZIP:__________ HOME PHONE:___________OCCUPATION:____________

EMPLOYER:_____________ OFFICE PHONE:___________ DATE OF BIRTH:__________ SOC. SEC. #: __________________

Rules & Regulations :

1. You and one guest are entitled to free admission to Vincent’s any night, with the exception of New Year’s Eve,
   events that involve advance ticket sales, any live entertainment, or any night/event as designated by management.
2. You must present your card each time you enter Vincent’s Nightclub as a member.
3. Enter through the VIP/Concierge door.
4. Proper dress is always required (no hats, sneakers, or jeans).
5. Proper identification for you and your guest AT ALL TIMES.
6. This membership is NOT transferable.
7. This membership is valid for one year.
8. Admission is contingent upon the legal capacity of the club.
9. Admission may be denied at any time by management for any reason.

I agree and understand that the management of Lombardo’s/Vincent’s Nightclub, has the right to refuse and/or cancel my membership for any reason, including any misconduct or disturbance on my part, or the part of my guest, while on the premises.

I further agree to be bound by all rules and regulations promulgated by management.
The rules and regulations may be changed at any time.

____________________________________________	________________
Signature	Signature Date

For Office Use Only:

Fee Paid___________Date Paid:_____________

Cash:_____________Credit Card:_____________________ Exp: ________

Date Card Issued_____________ Lead Source:_______________________

Manager’s Signature:____________________________________________

Print out this form, fill it out and return it with payment to our hostess on your next visit to Vincent's.