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Loyal Member Discount Club Enrollment

The following information will be added to our database in order to allow us to begin your membership. Again, there is no charge and you receive a lifetime 8% discount on all local merchandise purchases. Furthermore, we can remind you about important occasions (optional). Simply fill in the information below and submit online!

Part I: Your address and contact information:
Name:    
Address:    
City:    
State:    
Zip    
E-mail:    
Work Phone:    
Home Phone:    
Part II (Optional): From the list below please enter a maximum of four (4) dates for which you would like to receive a reminder by entering the month/day in the space provided:
Spouse Anniversary: Child Anniversary:
Spouse Birthday: Child Birthday:
Parent Anniversary: Grandparent Anniversary:
Parent Birthday: Grandparent Birthday:
Other Date to Remember:    
Other Date to Remember:    

Thank you!
MyFlorist

Before you submit the form, copy the characters that you see in the image above into the box below.
(case sensitive)