Sam’s Club® Group Membership Program
We are pleased to announce our partnership with Sam’s Club® to bring you the benefits of Membership through their new
Group Membership Program. By purchasing a Group Membership, we are offering you, our valued employees, a way to save
on personal items for yourselves and your families. Already a Sam’s Club Member? Our Group Membership enables us to
renew your current Membership for 12 months under the Group Program rate!
Our Company has agreed to participate in Level 1 (50 – 999 employees at $30 each)
As an added benefit, our company has agreed to pay $ towards the $30 Membership fee.
Our Company has agreed to participate in Level 2 (1,000+ employees at $25 each)
As an added benefit, our company has agreed to pay $ towards the $25 Membership fee.
In order for our Group Account to be set up, we need to submit a roster with our Group Participants’ Membership Application
information. Please let us know your interest in joining the Group by completing the attached Group Enrollment Form and
returning to our Group Account Administrator by the date specified below.
Group Account Administrator Name:
Phone / e-mail: Date Due:
Sam’s Club Group Membership Program
Interest and Enrollment Form
Group Company Name:
YES, I would like to participate NO, I would not like to participate
fill in last 9 digits
Sam’s Club Telephone #
of current First Name Last Name
Member? (xxx) xxx-xxxx
(as appears on
Address 1 Address 2 City ST
*$30 Reduced Membership Rate applies for Groups with minimum 50 - 999 employees. $25 Reduced Membership Rate applies to Groups with
minimum 1,000 or more employees. All Membership is subject to Sam’s Club Rules, and Sam’s Club reserves the right to accept, refuse, or revoke
Membership without cause. This flyer is for informational purposes only and any alteration of the content is prohibited and may result in refusal or
revocation of Membership. Please visit samsclub.com or the Member Services Desk at your local Sam’s Club for the full Conditions and Privileges