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Registration Form

Find out about benefits of Casa Mia Loyalty card

Please complete all fields marked with an asterisk (*).

Title* Please select... Mr Mrs Miss Other (Please specify)

Please specify

Forename*
Surname*
Address 1*
Address 2
Postcode*
Date of birth*
Home tel no*
Email*

Are you on our database? Yes
No

Do you have any other loyalty cards? Yes
No

Which ones?

How often do you visit a Casa Mia restaurant? Please select... Weekly Fortnightly Monthly Every six months
Which restaurant do you frequent most? Please select... Casa Mia Coffee Shop Casa Mia Grande Casa Mia Millennium Pronto Veuve Bar de Champagne
Do you use any of the following Casa Mia services? Christmas and New Year
Master Classes
Outside Catering
Wine Offers
Speciality Cakes
Gourmet Evenings
Christmas Hampers
On Line Shop
Web Site

I do not wish to receive any promotional material from Casa Mia.