top of page

High End Cigars

Locker Membership Agreement

Start Date
Month
Day
Year
End Date
Month
Day
Year

If you select a shared membership type please complete page 2 of this form with Member #2's Information.

Membership Type
Gold Single $1,000
Gold Shared $1,400
VIP $1,600
VIP Shared $2,000
Payment Type
Payment Date
Month
Day
Year

Member Information

Which best describes your cigar preference (Region):
US/Connecticut
Dominican Republic
Honduras/Nicaragua
Mexico
Cameroon/Central African Republic
Other Region
Body Type
Light/Medium
Medium/Full Bodied
Boutique Cigars
bottom of page