|
Membership Card Information
|
|
|
Membership Number: *
|
|
Verification Number: *
|
|
|
* The verification code is displayed on the back of your card. If your card does not have a verification code please enter the last four digits of the card number into this field.
|
|
|
Membership Login Details
|
|
|
|
|
Email: *
|
|
Password: *
|
|
Confirm Password: *
|
|
|
|
|
|
Membership Details
|
|
|
First Name: *
|
|
Last Name: *
|
|
Date of Birth: *
|
01 |
02 |
03 |
04 |
05 |
06 |
07 |
08 |
09 |
10 |
11 |
12 |
13 |
14 |
15 |
16 |
17 |
18 |
19 |
20 |
21 |
22 |
23 |
24 |
25 |
26 |
27 |
28 |
29 |
30 |
31 |
|
|
Jan |
Feb |
Mar |
Apr |
May |
Jun |
Jul |
Aug |
Sep |
Oct |
Nov |
Dec |
|
|
|
Mobile:
|
|
Preferred Store: *
|
Shift8 Test Location |
UNDEFINED |
Shift8 Skewerz |
Head Office QLD V2 |
Head Office WA V2 |
Stockland Townsville |
Garden City |
Mandurah |
Midland Gate |
Cockburn Gateway |
|
| |
|
Gender:
|
|
Address:
|
|
Suburb:
|
|
Postcode:
|
|
State: *
|
Australian Capital Territory |
New South Wales |
Northern Territory |
Queensland |
South Australia |
Tasmania |
Victoria |
Western Australia |
|
|
| Error has occurred |
|
|
|
|
|
|
|
|
|
|
|
* Fields marked with an asterisk are mandatory for registration.
|
|
|
|
|
|
|
|
|
|