New Member / Membership Renewal application form

To become a Tabaret Rewards member, simply complete an application form, print it off and give it to the cashier at your Tabaret venue!

Are you a

current member

new member

Mr

Mrs

Ms

Surname
First Name

Male

Female

Birthdate

Postal Address
Suburb

State

Postcode

Phone
Phone AH
Mobile
Email

I’d like to receive all offers by email only

Membership number (if applicable)

Partner's Details
Name
Postal Address
Suburb

State

Postcode

	Tick here if you DO NOT want to receive information about future Tabaret promotions (which may include information in relation to gambling, including electronic gaming machines ('Pokies')).
	I hereby certify that I am 18 years of age or above and I acknowledge that all transactions with Tabcorp holding Limited are governed by the Gambling Regulation Act 2003, any amendments thereto, and any rules and regulations made thereafter and the Tabaret Rewards terms and conditions of venue. I further acknowledge I enter the program accepting the terms and conditions under which the Tabaret Rewards Program is operated.
	I have read the Terms & Conditions

Signature: ______________________________

Date: ____  /  ____  /  ____________

OFFICE USE ONLY Venue: _________________________

Membership Number: ________________________