Membership Application – The La Crosse Club

La Crosse Club Member Application

Membership Type

Additional Designees may be submitted for a Corporate Membership after registration.

Individual Membership (Putnam Founder’s Membership)

Scholar & Residency Membership (21 years+)

Corporate Membership

Applicant Sponsored By(Required)

Current La Crosse Club member sponsoring this application.

Applicant Name(Required)

First Last

Business or Profession(Required)

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Applicant Phone(Required)

Applicant Email(Required)

Spouse/Partner (if applicable)

First Last

Spouse Phone

Spouse Email

Name

This field is for validation purposes and should be left unchanged.