Current Participating
Bars&Clubs
Name: Gender:
Phone: Age:
Email: Marital
Status
Address: Apt:
City:    
State: Zip:
45 Day Free Trial Offer
I hereby agree to try the Club VIP Entertainment Card absolutely FREE for 45 days.45 days from now I understand my credit card will be charged the amount selected below for my yearly membership fees. I may cancel within the first 45 days, with no further obligation by returning my Club VIP Entertainment Card to the below address with a written request to cancel.
The card must be returned to cancel billing at anytime.
Payment Plans:(select one)
$150 per year (one payment)
$20 per month (12 payments)
Card Type:    
Credit Card Number:   Expiration
Name as it appears on the card.  
I HEREBY APPLY FOR A ONE-YEAR PRIVATE MEMBERSHIP IN CLUB VIP AND CERTIFY THAT I AM ATLEAST 21.
D.O.B.
I have read and agree to the Club Vip Entertainment Card Terms and Conditions.
Club VIP Entertainment Phone:
1700 E. Thomas Rd. (602) 393-0568
Phoenix, AZ 85016 Fax
(602) 393-7186

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