Wizards of Oz Application

Please complete this application to join our loyalty program.

Note that your information will never be sold or shared. Period.

    * - Required Information

    Your Name

    First-*   MI   Last-*

    Email address-*  
    Ok to email about Specials and Events, etc.?

    Phone number  
    Ok to send text messages to this number?

    Mailing address

    Line 1-*  

    Line 2  

    City-*   ,   State-*     Zip-*

    Home Store-*  

    Your gender:   FemaleMaleUnspecified

    Your Birth date-*  

    Other important date  

    What is it (Anniversary, Groundhog Day, etc)?  

    If you'd like us to follow you, please share your social media handles

    Twitter   @     Untappd  

    Your Favorites

    Favorite Brewery  

    Favorite Beer  

    Hard-to-find beer you'd like us to keep an eye out for?  

    Favorite Radio Station?  

    Notes (anything you want us to record on your permanent record at The Daily Growler)