“a-list” APPLICATION Name * First Name Last Name Email * Phone * (###) ### #### Membership Type? * Wine Only Full Membership Still Unsure Birthdate * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country What are your pronouns? * She/Her He/Him They/Them Other Prefer Not To Say Ethnicity * Asian American Indian Black or African American Latino Native American/Alaska Native Native Hawaiian or Asian Pacific Islander White Other Prefer Not To Say What industry do you work in? * Work Email * How do you spend your free time? * What are your creative interests? * What is your favorite work of art or artist? * What is your favorite wine? * Social Handles? * If money were no object, what would you be doing at this very moment? * CC # * Your card will only be charged if your application is accepted. Exp CVV * Billing Zip * We can’t wait to get to know you a little better. xoxo AB
