Crown Room Club DELTA CROWN ROOM CLUB MEMBERSHIP APPLICATION

Please print or type and mail to:

Delta Air Lines
Crown Room Club Membership
P.O. Box 102171
Atlanta, GA 30368-2171

All applicable information must be filled in completely.


Are you currently a SkyMiles member?
|___| Yes.
SkyMiles Membership Number:

|___|___|___|___|___|___|___|___|___|___|

|___| No. If you are not a member, you will be automatically enrolled as a General member.


Name
|___| Mr. |___| Mrs. |___| Ms.
|___| Other__________

First Name MI Last Name


Mailing Address
|___| Home |___| Business


Company Name


Job Title


Street Address   Suite No.


City State Zip

Check here if the above is a change of address.

  Type of Membership (check one):

SkyMiles General Member

  |___| Annual $350
  |___| Annual with spouse $600
  |___| Annual -- 50,000 Miles
  |___| Annual with spouse -- 65,000 Miles

SkyMiles Silver Medallion™ Member

  |___| Annual $275
  |___| Annual with spouse $450
  |___| Annual -- 40,000 Miles
  |___| Annual with spouse -- 55,000 Miles

SkyMiles Gold Medallion™ Member

  |___| Annual $225
  |___| Annual with spouse $375
  |___| Annual -- 30,000 Miles
  |___| Annual with spouse -- 40,000 Miles

SkyMiles Platinum Medallion™ Member

  |___| Annual with spouse $150
  |___| Annual with spouse -- 10,000 miles

Form of Payment (check one):
|___| Check |___| Credit Card
|___| Money Order |___| SkyMiles
|___| Delta Frequent Flyer Miles

Credit Card Name_________________
Expiration Date__________

Credit Card Number:

|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

If you are requesting a membership for your spouse, please list your spouse's full name.
If spouse's surname differs from yours, a copy of your marriage certificate must accompany this application.

Mr. Mrs. Ms. Other__________


Spouse's First Name MI Last Name



Terms and Conditions of Crown Room Club Membership

  1. The Crown Room Club membership and card are for the exclusive use of the person whose name is imprinted on the front of the card and are not transferable or refundable. Use of the membership constitutes acceptance of the Crown Room Club Terms and Conditions. Crown Room Club members must be at least 21 years of age. Memberships will be terminated for inappropriate conduct, including but not limited to conduct that is disruptive, abusive or violent, or for non-compliance with the membership Terms and Conditions.
  2. The Crown Room Club membership card is required for admittance to the Crown Room. You must show your membership card to the host or hostess each time you enter. The card is property of Delta Air Lines and must be returned upon request or demand.
  3. A member may bring two guests into the Crown Room Club, provided that Delta, in its sole discretion, determines that adequate space and conditions exist. Guests' privileges apply only when the visitors accompany the member. Guest privileges are subject to Crown Room Club Terms and Conditions.
  4. Attire and conduct in a Crown Room Club must be in keeping with good taste and a dignified atmosphere. Tank tops, T-shirts, thong sandals and other inappropriate attire will not be permitted.
  5. Food and beverages may not be brought into the Crown Room Club. Alcoholic beverages may not be removed from the facility. Smoking is not permitted.
  6. Delta Air Lines reserves the right to revise its Terms and Conditions at any time without notice to members. Crown Room Club members will not be compensated, monetarily or otherwise, for the temporary or permanent closure of a club facility, for a change in policy or for termination of membership for failure to follow Crown Room Club Terms and Conditions.
  7. Crown Room Club facilities may be used only in conjunction with same-day ticketed air travel on Delta or the Delta Connection® carriers.
  8. Alcoholic beverages will not be served to anyone under 21 years of age. No one under the age of 21 will be allowed access into a Crown Room Club without being accompanied by a supervising adult.
  9. Airline, airport and industry employees traveling on reduced rate tickets are not eligible for membership.
  10. Crown Room Clubs are not to be used for groups. Business meetings and job applicant interviews are permitted only in Crown Room Club conference rooms and are subject to Terms and Conditions for conference room usage. Product demonstrations are prohibited.

    In consideration of acceptance of my membership in Delta Crown Room Clubs, I agree to abide by and be subject to all the Terms and Conditions of membership as established from time to time at the sole discretion of Delta Air Lines.



Signature of Applicant   Date


For CTO/FTO use: Receipt #______________________ Station ___________________
0432-07022 APPLICTN 2/99
©1999 Delta Air Lines, Inc. Printed in U.S.A. 2/99 PID#7842