Birthday Registration form

‘being in love is not looking into each others eyes, but looking in the same direction’ – ginger rogers

register your details for a chance to win our regular draw for a $500 birthday voucher that can be redeemed at mermaids.

dream how you would use it – intimate lunches and dinners – a group birthday bash – towards a larger birthday function – and yes, we could theme the function for you.

first name
last name
email address
contact phone (so we can call you when you win)
birth day	select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
birth month	select Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
postcode
Please input validation code?
All fields are required