Name:                     

Address:

City:   ST:   Zip:

Phone:   

E-Mail Address:

Number of persons:             

Credit Card Number:                 

Security Code:              

Expiration:

Registration type:

            Tasting Only @ $20.00/person for non-wine club members - club members are free.

            VIP Tasting @ $25.00/person (This event is open only to Wine Club members.)

By submitting this form, I authorize Mainstreet Wines and Liquors to charge the $20.00/$25.00 Per person cost to the credit card I have listed.

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