Wine Club Membership Registration Form

Wine Club Membership Form

Complete the form below to sign up for our membership service.
Name *

First Name Last Name
E-mail *
Phone Number: *

Area Code Phone Number

Address: *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Birth Date: *

Month Day Year

Shipping Address if Different from Billing Address (Sorry, we can not ship to PO boxes)

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Membership Level: *
Is this a Gift Membership? *
Terms and Conditions
1. Club membership is ongoing and may be cancelled any time by contacting the Wine Club Coordinator (30-days notice required).
2. Any changes in contact information, shipping address or payment information should be conveyed immediately to the Wine Club Coordinator to avoid delays in shipping and/or additional shipping charges for returned shipments.
3. An adult over the age of 21 is required to sign for the wines upon delivery and/or pick-up wine club releases at our winery.
4. Member benefits are not transferable to non-members.
5. For members who opt to pick-up orders at the winery, wine may be held for 60 days. After 60 days, the wine is shipped to the address on file at member's expense.
6. By signing this form, you declare that you are at least 21 years of age and have read and agree to the Terms & Conditions of membership. You also authorize Miner’s Leap Winery to automatically bill your credit card for wine club releases, including all applicable shipping fees and taxes for the club you have chosen.
7. We look forward to having you as a part of the Miner’s Leap family. Cheers!
Club Terms *

I have read, understood, and accepted the rules for membership.
After submitting this form, you will receive a followup call and/or email from our Wine Club Coordinator, within 48 hours to gather your payment information and confirm your member details.

Thank you!
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Wine Club Membership Form

Terms and Conditions