Club Membership Registration Form

Wine Club Membership Registration

Complete the form below to sign up for our wine club.
Name *

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

Area Code Phone Number
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Birth Date: *

Month Day Year
Where did you hear about us?

A Friend or colleague Social Media Website News Article
Membership Rules
By accepting this wine club agreement, I decalre that I am at least 21 years of age and have read and agreed to the terms and conditions of mempership. I also authorize The Urban Cork to automatically bill my credit card for my wine club releases, including all applicable fees and shipping (if choosen) on the 5th of the month of the releaes months for the club I have chosen. If I choose to ship, I acknowledge that I ust have someone 21 years or older to sign for my delivery. I understand there is a one year commitment to each club and that if I don't come to pick out my order, it can be chosen for me.
Wine Club Agreement *

I have read, understood, and accepted the rules for membership.
Wine Clubs (4 releases annually)

Released February, May, August & November
Select Your Wine Club Level *

Winemaker's Pick- Choose one case from our current offerings each release at a 20% discount. Member's Choice- Choose six bottles from our current offerings each release at a 15% discount. Comparison Club- Choose four bottles from our current offerings each release at a 10% discount.
Once you submit your membership, we will contact you shortly to complete your membership account.

Thank you!
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Wine Club Membership Registration

Membership Rules

Wine Clubs (4 releases annually)