Wine Sign Up Form Syndicate Wine Club Name* First Last Address* Street Address Address Line 2 City ZIP / Postal Code Are you over 21 years of age?*YesNoDate of Birth* Date Format: MM slash DD slash YYYY Email* Phone Number*Credit Card NumberExp DateCCVWine Preferences* Two (2) Whites (approx. $50/mth) One White, One Red (approx. $65/mth) Two (2) Reds (approx. $80/mth) For your White Wines, do you prefer Sweet or Dry?SweetDryFor your One White, One Red, do you prefer Sweet or Dry? Medium or Full-Bodied?SweetDryMedium-BodiedFull-BodiedFor your Red Wines, do you prefer Medium or Full-Bodied?MediumFull-Bodied “The Syndicate” Wine Club Benefits include the following: 10 % off all purchases at Syndicate Wine Bar Monthly club pick up parties (tastings, food pairings, music) Exclusive club only discounts at Club Pick Up Parties Exclusive Access to Club Only releases Dial ahead decanting privileges for Happy Hour Unique wines from around the world (not just Oregon, not just Pinot Noir) 2 Syndicate Wine Bar Oregon Pinot glasses 24 total bottles a year (12 monthly selections at 2 bottles a month) Legal Requirements You must be 21 years of age or older, to order or receive alcoholic beverages from Syndicate Wines, LLC dba Syndicate Wine Bar. Receipt of shipments containing alcoholic beverages requires the signature of a sober adult (a person 21 years of age or older who is not intoxicated). Wines purchased from Syndicate Wines, LLC dba Syndicate Wine Bar are not for resale, and are for personal consumption only. Credit Card Authorization By signing below, you authorize Syndicate Wines, LLC dba Syndicate Wine Bar to charge your card for monthly wine club at the time of pick up. To cancel at any time, please notify Syndicate in writing at email@example.com.Signature*Please type your name to enroll in the above selected Wine Club(s)Today's Date*NameThis field is for validation purposes and should be left unchanged.