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 the Community of S-Fellowships like COSA, ISA, RCA, SA, SAA, SLAA, SCA, SRA, S-Anon, and others. The Community is open to the addict and their partner or significant other. We offer 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. All PII is kept confidential.

Member Information

Name:                                                                                                                                

Address:                                                                                                                           

City:                                                                          State:                                Zip:       

Phone:                                                    E-mail:                                                             

Please specify your primary S-Fellowship (circle one organization below):
SAA   SLAA   ISA   COSA   RCA   SA   SCA   S-Anon   SRA

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:

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

Today’s Date: ____________

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. — 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 is only open to adults (18 or older) and no children or minors are allowed.