Membership Form
Single Gourmet
3840 West Hillsboro Blvd. #122
Deerfield Beach, Fl 33442
Click on the green button above to print out a printer friendly Membership Form, fill out all pages and mail with a check or money order for the membership fee of $99. (One year) or $149. (Two Years) to our Corporate offices at the address listed above to get started with Single Gourmet.
Name: ______________________________________________________
Address: ____________________________________________________
Bldg. # ________________________ Apt. # _______________________
City: __________________________ State: __________ Zip: _________
Home Phone # _______________________________________________
Work Phone # _______________________________________________
Cell Phone # _______________________________________________
E-Mail Address _______________________________________________
Current Marital Status:
( ) Never Married ( ) Separated ( ) Divorced ( ) Widowed
( ) Male ( ) Female
Date of Birth:________________________________________________
Circle Age Range You Wish To Be Seated In – Please Be Realistic
21+ 25+ 30+ 35+ 40+ 45+
50+ 55+ 60+ 65+ 70+ 75+
Membership: ( ) One Year - 99. ( ) Two Years – 159. (Save $50.)
How did you hear about us: ____________________________________
Occupation: __________________________________________________
Employer: __________________________________________________
Date: _______________________________________________________
Signature: __________________________________________________
Serving all of the South Florida tri-county area.
Broward County Palm Beach County Miami-Dade County
954-723-9608 561-276-2595 305-371-8717
Who may attend events: The South Florida chapter of The Single Gourmet consists of three individual chapters. Broward County, Palm Beach County and Miami-Dade County. Each area has its own events, but as a courtesy, we do show the listings of all three areas in our monthly newsletter. If a member would like to attend some events in another county, they are certainly welcome. If they choose to attend events only in their county, that’s OK too. Only members of the The Single Gourmet may attend.
CONSUMER’S RIGHT OF CANCELLATION: YOU MAY CANCEL THIS CONTRACT WITHOUT ANY PENALTY OR OBLIGATION WITHIN 3 BUSINESS DAYS FROM THE ABOVE DATE, AND RECEIVE A FULL REFUND OF ALL PAYMENTS MADE TO THE SELLER. YOU MAY ALSO CANCEL THIS CONTRACT UPON A DOCTOR’S ORDER YOU CANNOT PHYSICALLY RECEIVE THE SERVICES, OR YOU MAY CANCELTHE CONTRACT IF THE SERVICES CEASE TO BE OFFERED AS STATED IN THE CONTRACT. IF YOU CANCEL THE CONTRACT FOR EITHER OF THESE REASONS, THE SELLER (THE SINGLE GOURMET) MAY KEEP ONLY A PORTION OF THE CONTRACT PRICE EQUAL TO A PRO RATA PORTION OF THE TOTAL PRICE REPRESENTING THE PROPORTION OF SERVICES YOU USED OR COMPLETED, PLUS THE COST TO THE SELLER OF ANY RELATED GOODS WHICH YOU CONSUMED OR RETAINED. THIS CONTRACT OR NOTE IS FOR FUTURE CONSUMER SERVICES AND PUTS ALL ASSIGNEES ON NOTICE OF THE CONSUMERS RIGHT TO CANCEL UNDER CHAPTER 2-18, FLORIDA ADMINISTRATIVE CODE.
E-Mail Announcements: The Single Gourmet will periodically send you e-mail calendars of events, updates or specific advertising about The Single Gourmet. By becoming a member of The Single Gourmet you agree to receive our e-mail. You may opt-out at any time by e-mailing us at SingleGourmetFla@aol.com
Signature _________________________ Date ___________

