Wine Club Membership Registration Form

Wine Club Membership Form

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

First NameLast Name
E-mail*
Phone Number:*

Area CodePhone Number
Home Address:*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Birth Date:*

MonthDayYear
Billing Address if Different from Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
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. Please notify the Wine Club Coordinator of any changes in contact or payment information.
3. An adult over the age of 21 is required to sign for the wines upon pick-up during wine club releases.
4. Member benefits are not transferable to non-members.
5. 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 applicable taxes, for the club you have chosen.
6. 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 the next week to gather your payment information and confirm your member details.

Thank you!
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Wine Club Membership Form

Terms and Conditions