BPT Membership Application

1
Please enter your legal name* This field is required.
Prefix
First Name
Middle Name
Last Name
2
Please enter your date of birth* This field is required.
Date
Day
Month
Year
3
Please enter your physical address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
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Montserrat
Morocco
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Nagorno-Karabakh
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Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
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Nigeria
Niue
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Palau
Palestine
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Paraguay
Peru
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Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
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Saint Helena
Saint Kitts and Nevis
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Saint Martin
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Samoa
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Senegal
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Other
Country
4
Please enter your email address* This field is required.
example@example.com
5
Please enter your phone number* This field is required.
Please enter your best contact phone number.
6
I would like to know more about the following activities at the Black PearlYou may tick as many as you like ...
Black Pearl Social Club
Pool Team
Darts Team
Wine Club
Pub Quiz Nights
Horse Racing
Live Music & Karaoke
Sweepstakes & Competitions
7
Terms & ConditionsSandown Holdings Limited trading as Black Pearl Tavern (hereafter known as Black Pearl Tavern) I wish to apply for membership at the Black Pearl Tavern. As a member I agree to the standard terms and conditions as follows – 1. That I am over the age of 18 years 2. That the information I have provided in this membership application is true and correct 3. That my membership card remains the property of Black Pearl Tavern 4. That any or all benefits offered under this membership agreement may be added to, altered, or withdrawn by Black Pearl Tavern 5. That I agree to receive promotional material from Black Pearl Tavern in the form of email, newsletter, post, SMS, text, phone or social media platform to inform me of upcoming events, points of interest and specials. 6. That Black Pearl Tavern by way of the duty manager reserve the right to cancel my membership at any time should they deem my behavior inappropriate, or if my conduct potentially brings the establishment in to disrepute including the safety or wellbeing of other members/patrons or staff 7. That in the event that my membership is revoked (verbally or written), I will return my membership card to the duty manager within 48 hours Privacy Policy: I understand that, pursuant to the Privacy Act 1993, I have the right to request access to and correction of any personal information held by Black Pearl Tavern Black Pearl Tavern hereby affirm that your personal information will not be on sold to any third party without your express written permission and will only be used to promote food, beverage, upcoming events and other points of interest that we may deem beneficial to its members as a whole.
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