Wine Club Membership

Please print and complete this form, mailing it to:
Adina Wine Club
492 Lovedale Road, Lovedale,
Hunter Valley NSW 2325

First Name  
Surname  
Street Address
(No PO Boxes
please)		  
State  
Postcode  
Delivery instructions if If no one is home when we deliver*
(if you leave this blank, your shipment will be left at your local post office for collection by you)
 
Email  
Phone  
Your date of birth ddmmyyyy (it is a legal requirement that purchasers must be over 18 years of age)  
Your wine preference Red White Mixed
Your wine preference I have read the Membership Conditions & agree
Sign  
Comments  

NOTE:
For security purposes, a member of our staff will contact you via telephone to obtain your credit card details. It is illegal to sell to, supply or obtain liquor on behalf of a person
under the age of 18 years.