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First Name

Last Name

Email Address

Phone

Address

Date of birth – (Must be at least 21 years old to apply)

Were you referred by a member? If so, who? If not, how did you hear about us?

Please tell us a little bit about yourself and your interests

Why are you interested in becoming a member of LBV and what do you hope to get out of your membership?

Do you have a wine cellar?

How long have you been interested in wine?

Who is your favorite artist (Living or Dead)? What is your favorite piece of architecture and/or who is your favorite designer?