Please register me with Table Talk Dining.
Name __________________________________________
Address_________________________________________
_________________________________________
H. Phone ____________________W. Phone ___________
Mobile ________________________________________
D.O.B. ________________________________________
(For security reasons and to ensure fairness for all members
you are required to supply us with Photo ID showing date of
birth and address i.e. Drivers Licence) This information is
confidential and is for our records only and will not be given
out to a 3rd party under any circumstances.
If paying by credit card please fax written authorisation and photo ID to 0243886628 or
I wish to register for the following membership:
Membership fees are NON REFUNDABLE under any circumstances. I agree to abide by all the Table Talk Dining
Rules and Regulations
______________________________________
Signature
Six Months $50.00
[ ] Renewal fees applicable
Twelve Months $75.00
[ ] Renewal fees applicable
Once Only $175.00
[ ] No renewals fees payable
I __________________________________authorise Table Talk
to charge my credit card for the above membership.
(Please phone with your credit card details. A 2% service fee applies to all Visa, Mastercard & 3% Amex credit
card charges. ) or Post to
Table Talk Dining
P.O. Box 5446
CHITTAWAY BAY 2261
0243623476
Fax 0243886628
