FUSION-X™ APPLICATION

Membership

FIRST NAME

LAST NAME

PRIMARY PHONE

ADDRESS LINE 1

ADDRESS LINE 2

TOWN / CITY

POSTAL CODE

COUNTRY

GENDER

DATE OF BIRTH

OCCUPATION

BUSINESS / COLLEGE NAME

POSITION HELD

NAME OF REFERRING MEMBER

MEMBER'S RECOMMENDATION LETTER

I DON'T KNOW AN EXISTING MEMBER

WHAT DO YOU THINK YOU WILL ADD TO THE SOMA COMMUNITY?

LINK 1 (e.g. work examples, LinkedIn)

LINK 2 (e.g. Instagram, Facebook)

LINK 3 (anything else)

PASSPORT PHOTO (if under 27)

PROFILE PHOTO (internal use only)

PAYMENT TERM

DESIRED MEMBERSHIP ACTIVATION DATE

I understand there is no payment at this point, until SOMA team contacts me directly with acceptance of application providing payment link.

I agree with the Terms & Conditions of the clubhouse.