I am a new applicant: __________ I am requesting a replacement card: __________
(PLEASE PRINT IN CAPITOL LETTERS USING A BLACK OR BLUE PEN. PLEASE ENSURE THAT THIS FORM IS SUBMITTED FULLY COMPLETED, ACCURATE AND LEGIBLE)
Contact Information | |
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Name |
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Street Address |
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City, Province, Postal Code
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Home Phone
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Work Phone
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E-Mail Address
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Membership Agreement
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By submitting this enrollment form, you signify your acceptance in the Lucky Days Bingo VIP Players Club. You accept that enrollment in the Players Club may entitle a member to special prizes, draws or events not otherwise offered to regular players. You acknowledge that the collection of VIP points has no cash value but may be exchanged for entry into special prize draws and other events as detailed by Lucky Days Bingo. The ‘value’ of collected points may change if the hall deems necessary.
Lucky Days Bingo undertakes to maintain in the strictest confidence all of the information provided by you. From time to time, we may provide you with information or special offers which we feel may be of interest to you.
If you do not wish to receive this information or these offers, please indicate here: ______
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Name (printed) |
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Signature |
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Date |
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NEW MEMBER CARD NUMBER # _________________________________________