Name *

First Name

Last Name

Phone *

(###)

###

####

Date Of Birth *

MM

DD

YYYY

I wish to receive special offers, vouchers, discounts and the latest information and news about gaming, food and beverages. *

Yes

No

Gaming Machine Player Government Requirements *

I agree to receive my Player Activity Statement, in accordance with Victoria Government legislation . (tick one box only)

via email

via kiosk

from venue

I am over the age of 18, I have reviewed and carefully read and understood the rules of the program. I agree to strictly abide by these Rules (including all Terms and Conditions), as amended from time to time and declare that the details in this Application are true and correct. *

Yes, Agree

Date *

MM

DD

YYYY