2010 NYBC   MEMBERSHIP APPLICATION

Please complete the application and bring it with you to our party or address all mail to :
NYBC , PO Box 20064,    New York NY   10014
Info Phone: 212-620-ROPE(7673)     Web site: http://www.nybondageclub.com

You will receive a stamp each time you pay and enter the club. When you have 10 stamps on your card, the next time you come to the club, you will enter for FREE. The stamps don't expire, and they are transferable when you renew your card!

Membership Benefits:
Discount on entry!
10% Discount if you shop at The Leatherman on Christopher Street!

I am over 18 years old(or 21 where required by law).  I do not object to nudity. 
It is legal for me to join an adult bondage s/m club in the location in which I reside. 
I am not a law enforcement officer nor am I representing any public or private organization .

* NAME : *required

*EMAIL:  *BIRTHDATE:

Most correspondence will be now be sent by email. On occasion we may send postal mail.

If you want postal mail, complete the following, otherwise leave blank.

ADDRESS: APT :

CITY: STATE: ZIP: PHONE :

We never release your name or address to any other organization. It is confidential!

By my signature below I certify that I am over 18 years of age, that I have read the rules for membership and
certify that I am able to join, and that I will not hold NYBC, New York Bondage Club, Inc., their officers,
or assigns, liable or responsible for the consequences of any meeting that I may attend or arrange.

Date: SIGNATURE:

Please print your name in the signature box, and then sign after you print the form.