To join a Regent Cinemas Movie Club, please complete the form below. After successful completion of this form you will be asked to choose your membership type and pay for your membership by credit card through the PayPal service.

There is a postage and handling fee of $2.50. Note postage and handling will take approx 7 working days.

First Name:
Initial and Surname:
Date of Birth:	JanFebMarAprMayJunJulAugSepOctNovDec 12345678910111213141516171819202122232425262728293031 192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006
Email Address:
Postal Address:
Suburb:
Post Code:
Telephone:
Mobile:
Cinema Facility of interest:	Gold Class Showcase Mainstream
Favourite Genres:	Action Horror Sci-Fi Comedy Romance Drama Classics Fantasy Documentary
Which best describes you:	I come to the movies on a weekly basis regardless of what is on I come to the movies on a public holiday/long weekend when I have nothing else to do I come to the movies every school holidays I only come to the movies for a major blockbuster release film I don't go to the movies very often
How often do you go to the movies?	I come to the movies 1 - 4 times per year I come to the movies 5 - 9 times per year I come to the movies 10 - 15 times per year I come to the movies 16 or more times per year
	I agree to the terms and conditions

Terms and Conditions Village Anderson Management Pty Ltd Regent Cinemas Movie Club Membership Card(s):

1. This document contains the terms and conditions governing the purchase and subsequent use of the Movie Club Membership Cards for associated goods or services from Village Anderson Management Pty Ltd ABN 42 891 786 227 trading as Regent Cinemas – Ballarat and/or Werribee (“VAM”).
2. Regent Cinemas Movie Club Membership Card(s) are sold for a retail value and include Movie Club, Kids Club, Seniors Club and Platinum Club and provide each purchaser with a 12 month membership.
3. Regent Cinemas Movie Club Membership Card(s) benefits are only valid at Regent Cinemas Ballarat and Werribee.
4. Movie Club Membership Card(s) are valid for 12 months from the date of purchase upon sign up to the respective Movie Club and as such the membership card will cease to operate after this period has expired.
5. A valid Regent Cinemas Movie Club Membership Card(s) must be presented to receive the respective offers that are available. Members are required to sign the signature panel on the back of their respective card and may be requested to present photographic identification to verify them as being the current member upon demand.
6. Any lost of stolen card should be reported to our Box Office staff. A replacement card fee of $5.50 incl GST will apply for each re-issued card with the lost one being immediately cancelled.
7. Any Regent Cinemas Movie Club Membership Card(s) can only be used once in any hour period and our point of sale system will identify and decline any Regent Cinemas Movie Club Membership Card(s) which attempts to breach this policy.
   
8. Kids Club membership is valid only to children 14 years of age and under. It is recommended to be sold to children under 14 years of age to enable the full 12 months of membership benefits. However, children aged 14 years or more can still purchase a Kids club membership; however they are only permitted to obtain its benefits up to when they turn 15 years of age.
9. Platinum Club Gold Class offer is only valid at Regent Cinemas Ballarat.
10. Seniors Club membership is valid to any person 60 years of age or more and who presents a current valid Commonwealth Government Seniors Card.
11. It is any member’s responsibility to notify Regent Cinemas of a change of address or if their membership card has not been received within four weeks from the date of purchase.
12. Regent Cinemas Movie Club Card(s) remain the property of VAM at all times. Any misuse or breach of these terms and conditions may lead to the applicable membership being cancelled with no refund on initial retail purchase being provided.
13. You will be required to provide Personal information to VAM as part of the application process to obtain your Regent Cinemas Movie Club Membership Card(s). If you do not provide that Personal information to VAM, your membership application cannot be completed and offer you the associated offers, goods and services. All Personal information VAM collects as part of this membership will be maintained in accordance with VAM’s Privacy Policy. Employees of VAM and its related bodies corporate are entitled to become members of the Movie Club Membership Card(s), but are not entitled to enter any competitions or similar activities where there may be a potential conflict of interest. VAM will use its reasonable endeavours to maintain security of any Personal Information that you provide. However VAM cannot give an absolute assurance that the information you provide to us will be secure at all times and customers who elect to purchase and become part of the Movie Club Membership Card(s) program do so on this understanding.
14. VAM may elect to share some of its Regent Cinemas Movie Club(s) membership information to other external companies or organisations to further enhance the offers to the membership and for commercially beneficial reasons.
15. Further information relating to our privacy statement can be found at www.regentmultiplex.com.au
    
16. All retail prices, associated benefits and offers are current as of Dec 24,2007 and may be subject to change without notice.
17. Any correspondence relating to the Movie Club Membership Card(s) program should be directed to the Marketing Co-ordinator, Regent Cinemas PO Box 277, Ballarat 3353.