Application

Thank you for your interest in Apiary. Your journey towards membership begins here! Please start by filling out this form. From here we will review your information and set up a time for you to have a call with one of our partners. In the meantime, please feel free to reach out to us with any questions by emailing membership@apiary.club. We look forward to meeting you soon.

"*" indicates required fields

Contact Information

Name*

First Name Last Name

Company*

Email*

Phone*

Spouse Name

Spouse First Name Spouse Last Name

Spouse Email

Spouse Phone

Street Address*

Street Address Address Line 2 City State ZIP Code

Referred by*

Please select which lounge you see yourself using more*

Shirt Size*

X-Small

Small

Medium

Large

X-Large

Other

Reserve a locker*

Wine (waitlist)

Cigar

Both (waitlist)

Neither

Type of Membership*

Individual Membership ($1,650)

Corporate Sponsorship ($4,950)

National (>250 miles from Omaha) ($250)

Billing address same as shipping

Billing Address*

Billing Address Billing Address Line 2 City State ZIP Code

Credit Card*

Card Number

Cardholder Name

Total

Discount Code

Comments

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