Membership Application

Please complete each section of the form below. Fields marked with a * are required.

Note: Once your application form is submitted, there is a required THREE day wait for membership approval. Show your ID and pick up your membership card at the door for $5.00. By submitting this form you agree to the rules and regulations enforced by Deep South The Bar and those stated on this website. We look forward to seeing you and your friends at Deep South The Bar!

*First Name:

*Last Name:

*Email:

*Street Address:

*Address 2 (Apt#)

*City / State / Zip:

* Home Phone:

*Mobile Phone:

*Date of birth: mm/dd/yyyy

*State License or ID is issued:

*Driver License # (or State ID):

1. How did you hear about Deep South The Bar? :

Other Source:

2. What is your favorite style of rock music?:

Other Music:

3. Who is your favorite music artist?

Other Artist:

Membership Terms and Conditions:

I have read and agree to the terms above

I am at least 21 years of age or older