WICKED CLUB MEMBER REGISTRATION

All information is strictly confidential and will not be made available to any other party. We do not sell our mailing list EVER

After you submit this form, you will be emailed an "Approved Member" letter which guarantees entrance to our VIP Suite (This may be revoked at any time if the information on your form is false or you do not respect the club rules)
PLEASE NOTE: EMAILS FROM THIS SYSTEM MAY INITIALLY BE BLOCKED BY SPAM FILTERS. PLEASE CHECK YOUR SPAM FOLDER IF YOU DO NOT RECEIVE AN EMAIL WITHIN A FEW DAYS

If you do not receive an approval email, it does not always mean your membership did not get approved. In some cases, we may approve new applicants after meeting them in person at the club (you may show up at the door, entrance will be at the discretion of the door) or receiving voucher by existing members.

 
Name ( His )
Occupation ( His )
 
Name ( Her )
Occupation ( Her )
 
Address Postal
City Prov  
Phone ( His) ( ) - Ext.
Best Time To Call AM / PM  
Phone Location
   ( His )
Phone ( Her) ( ) - Ext.
Best Time To Call AM / PM
Phone Location
   ( Her )
email
Birthday ( His )         (mm/dd/yyyy)
Birthday ( Her )         (mm/dd/yyyy)

Please Provide Images Of Yourself

(Images must be valid for membership approval - We recommend you "save as" your file picture on your desktop with either your first names or your handle first.

Example: johnandmary2007-06-05 or TOcouple2007-06-05)


Click The Browse Button To Select An Image File On Your Computer.

Image 1    Recomended Size ( 100 w X 100 - 150 h )

Image 1 Preview:


Image 2    Recomended Size ( 400 w X 450 h )

Image 2 Preview:


Brief Description of yourself
 

DISCLAIMER



RULES AND REGULATIONS       I agree 
PHOTO ID

PROOF OF AGE MAY BE REQUIRED (at the discretion of the door) FOR ANYONE UNDER 25. Please bring valid photo ID for that purpose.

Membership is not Guaranteed!