Apartado 31, 8300-999 Silves, Portugal
Tel: 282 441 036 - Fax: 282 441 037
E-mail: mail@winemine.net


MEMBERSHIP APPLICATION

Enclosed please find my cheque for € 20, made out to WineMine, Lda.,
to cover one years membership of WineMine Wine Club.

Name
Address
Postal Code
Telephone
Fax
Mobile
E-mail
Date
Signature	.....................................................................................................