Membership Application

OUTER CIRCLE CLUB

Thank you for wanting to join the Outer Circle Club and take your recovery to the next level!

Your interest and continued support are essential as we continue to grow the first-ever “Twelve Step Club” exclusively serving Houston’s COSA, ISA, RCA, SA, SAA, SLAA, SCA, S-Anon, and other “S” Fellowships and their partner or significant others through education and practice. Our vision is to create a safe recovery environment at a dedicated and accessible facility**.

The following information is considered “personally Identifiable Information (PII)” and is available only to Club Directors and those who the Board deems necessary to conduct ordinary business.

Member Information

Name:                                                                                                                                

Address:                                                                                                                           

City:                                                                          State:                                Zip:       

Phone:                                                    E-mail:                                                             

Please specify your “S-Group” fellowship (e.g., SAA, SLAA, ISA, etc.)          

May we use your E-mail address to communicate with you? ___ Y   ___ N
If this field is left blank, the Club will use your E-mail address to communicate with you until you opt-out.

Note: We only use your email address to notify you of Club events and to provide news about activities. Your private personal information is only accessible by the Board of Directors; we neither release nor disclose your private personal information unless authorized by a valid court order.

Dues:

$120 for a 6-month membership or $200 for a 12-month membership. Cash, check, or credit cards (PayPal is coming!). If paying by check, please make the payee out to the “Outer Circle Club.”

Payment: $ ____________

Additional Donation: $ ____________

TOTAL PAYMENT: $ ____________

The Outer Circle Club was organized on September 20, 2011, as a Texas non-profit corporation having received federal tax-exempt approval per Section 501(c)(3) of the Internal Revenue Code. Upon request, receipts for donations over $250 are provided in January of the following calendar year and may be used to support any deductions on your personal income tax return. — Board of Directors

Mailing Address

Outer Circle Club
P.O. Box 540792
Houston, TX 77254-0792
Membership@OuterCircleClub.org
813-930-CLUB (2582)

** The Outer Circle Club cannot accommodate children or minors.