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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*
What name do you want on your card (maximum 20 characters)*
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... Bar Ischia Casa Mia Coffee Shop Casa Mia Grande Casa Mia Millennium
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

Join our mailing list

Make a Reservation

Make a reservation

Restaurant Choose restaurant Casa Mia Grande Casa Mia Millennium
Date Sat 17 May 2008 Sun 18 May 2008 Mon 19 May 2008 Tue 20 May 2008 Wed 21 May 2008 Thu 22 May 2008 Fri 23 May 2008 Sat 24 May 2008 Sun 25 May 2008 Mon 26 May 2008 Tue 27 May 2008 Wed 28 May 2008 Thu 29 May 2008 Fri 30 May 2008 Sat 31 May 2008 Sun 01 Jun 2008 Mon 02 Jun 2008 Tue 03 Jun 2008 Wed 04 Jun 2008 Thu 05 Jun 2008 Fri 06 Jun 2008 Sat 07 Jun 2008 Sun 08 Jun 2008 Mon 09 Jun 2008 Tue 10 Jun 2008 Wed 11 Jun 2008 Thu 12 Jun 2008 Fri 13 Jun 2008 Sat 14 Jun 2008 Sun 15 Jun 2008 Mon 16 Jun 2008 Tue 17 Jun 2008 Wed 18 Jun 2008 Thu 19 Jun 2008 Fri 20 Jun 2008 Sat 21 Jun 2008 Sun 22 Jun 2008 Mon 23 Jun 2008 Tue 24 Jun 2008 Wed 25 Jun 2008 Thu 26 Jun 2008 Fri 27 Jun 2008 Sat 28 Jun 2008 Sun 29 Jun 2008 Mon 30 Jun 2008 Tue 01 Jul 2008 Wed 02 Jul 2008 Thu 03 Jul 2008 Fri 04 Jul 2008 Sat 05 Jul 2008 Sun 06 Jul 2008 Mon 07 Jul 2008 Tue 08 Jul 2008 Wed 09 Jul 2008 Thu 10 Jul 2008 Fri 11 Jul 2008 Sat 12 Jul 2008 Sun 13 Jul 2008 Mon 14 Jul 2008 Tue 15 Jul 2008 Wed 16 Jul 2008 Thu 17 Jul 2008 Fri 18 Jul 2008 Sat 19 Jul 2008 Sun 20 Jul 2008 Mon 21 Jul 2008 Tue 22 Jul 2008 Wed 23 Jul 2008 Thu 24 Jul 2008 Fri 25 Jul 2008 Sat 26 Jul 2008 Sun 27 Jul 2008 Mon 28 Jul 2008 Tue 29 Jul 2008 Wed 30 Jul 2008 Thu 31 Jul 2008 Fri 01 Aug 2008 Sat 02 Aug 2008 Sun 03 Aug 2008 Mon 04 Aug 2008 Tue 05 Aug 2008 Wed 06 Aug 2008 Thu 07 Aug 2008 Fri 08 Aug 2008 Sat 09 Aug 2008 Sun 10 Aug 2008 Mon 11 Aug 2008 Tue 12 Aug 2008 Wed 13 Aug 2008 Thu 14 Aug 2008 Fri 15 Aug 2008 Sat 16 Aug 2008 Sun 17 Aug 2008 Mon 18 Aug 2008 Tue 19 Aug 2008 Wed 20 Aug 2008 Thu 21 Aug 2008 Fri 22 Aug 2008 Sat 23 Aug 2008 Sun 24 Aug 2008
Time No restaurant selected People 1 2 3 4 5 6 7 8 More than 8

Prefer to call? Yes

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