Cannery Casino Can Cub

You can sign-up today and become an C.A.N. Club Member by filling out this simple application. Thank you, we look forward to seeing you.

All RED fields with * are required.

First Name:*	MI:
Last Name:*
Gender:*	M F
Birthday: * (mm/dd/yyyy)
Anniversary: (mm/dd/yyyy)

Address:* (street or PO Box)
Apt #:
City:*
State:*
Zip:*
Country:*
	Would you like to receive mail offers? Yes No

Phone #:
	Would you like to receive phone correspondence? Yes No
Email:*
	Would you like to receive email offers? Yes No

Do you currently have a North Las Vegas Cannery Players’ Club Card?
Yes No
If yes, please provide Cannery Can Club #:

Do you currently have a Nevada Palace Players Circle Card?
Yes No
If yes, please provide Nevada Palace Players Circle Card #:

By submitting this form, I certify that I am at least 21 of years of age and that all representations made by me on this form are true and accurate