BEER CLUB

NAME *

First Name

Last Name

BIRTH DATE *

MM

DD

YYYY

PHONE NUMBER *

(###)

###

####

ADDRESS *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Expiration Date *

MM

DD

YYYY

YOUR PAYMENT WILL NOT BE CHARGED UNTIL THE FIRST OF THE NEXT MONTH. *

I UNDERSTAND

I HEREBY CONFIRM THAT I AM 21 YEARS OF AGE OR ABOVE AND THAT I AGREE TO THE ABOVE SELECTED MEMBERSHIP PAYMENT TO BE CHARGED TO THE AFOREMENTIONED ACCOUNT EACH MONTH. *

I HEREBY CONFIRM

PLEASE ALSO NOTE THAT YOU MAY CANCEL YOUR MEMBERSHIP AT ANY TIME BEFORE THE 20TH DAY OF EACH MONTH. IF THE CANCELLATION OCCURS AFTER THE 20TH, YOU WILL BE CHARGED FOR THE UPCOMING MONTH'S MEMBERSHIP AND MEMBERSHIP WILL AUTOMATICALLY CANCEL AFTERWARD. *

I UNDERSTAND

IF INITIAL SIGN UP OCCURS AFTER THE 15TH OF THE GIVEN MONTH MEMBERSHIP WILL COMMENCE THE FOLLOWING MONTH. THUS, IF YOU SIGN UP BEFORE THE 15TH YOU WILL BECOME A MEMBER FOR THE REMAINDER OF SAID MONTH. *

I UNDERSTAND