Member Names
First Name
Last Name
Discovery Co-op Membership Number
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Preferred Pick-up Location
*
Carlton Trail
Territorial
Railway
Radisson*
*Will be available one week later than other pick-up locations due to shipping constraints.
How many bottles would you like every month? (Note: Average will be $20-40 before tax)
Basic Wine Preferences (Check however many may apply)
Which wine regions do you enjoy and would most like to explore?
*
North America
South America
France, Italy, Spain, Greece & Portugal
South Africa
Australia/New Zealand
Germany, Austria & Hungary
I have read and agree to the Wine Locker Program Policies
Signature
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