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Today’s Date:
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Activation Date:
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Store:
MEMBERSHIP SIGN UP PRIMARY MEMBER INFORMATION First Name:
Last Name:
Company Name: Address: City:
State:
Home Phone:
Cell Phone:
Email:
Birthday (mm/dd):
At which locations do you most frequent?
Branford
Zip:
¨ North Haven
¨ Bethel
¨ Manchester
¨ Middlefield
¨ North
¨ Southington (Check all that apply. Circle favorite if more than 1 is checked.)
¨ Yes! please send weekly sales newsletters, store events, and announcements to my email address. Preferred contact method: ¨ Snail Mail ¨ Email ¨ Text Message Signature:
Today’s Date:
TELL US ABOUT YOUR PETS (up to 5 pets may be added)
Receive an annual gift within the pet’s birthday month + bonus Club points with your first pet profile! Pet 1 Name:
Pet 2 Name:
Pet 3 Name:
Pet 4 Name:
Pet 5 Name:
Pet 1 Type:
Pet 2 Type:
Pet 3 Type:
Pet 4 Type:
Pet 5 Type:
Breed:
Breed:
Breed:
Breed:
Breed:
Birthday (mm/dd/yyyy):
Birthday (mm/dd/yyyy):
Birthday (mm/dd/yyyy):
Birthday (mm/dd/yyyy):
Birthday (mm/dd/yyyy):
Pet 1 Favorite Food:
Pet 2 Favorite Food:
Pet 3 Favorite Food:
Pet 4 Favorite Food:
Pet 5 Favorite Food:
Pet 1 Favorite Treats:
Pet 2 Favorite Treats:
Pet 3 Favorite Treats:
Pet 4 Favorite Treats:
Pet 5 Favorite Treats:
¨ Cat ¨ Dog ¨ Other:
¨ Cat ¨ Dog ¨ Other:
¨ Cat ¨ Dog ¨ Other:
¨ Cat ¨ Dog ¨ Other:
¨ Cat ¨ Dog ¨ Other: