Become a Life Rewards Card Holder Today

Please complete all compulsory fields marked with * so that we can post to you, your Life Rewards card. 

Email Address* First Name* Mobile Number* Surname* Phone Number* Fax Number Have you received your Life Rewards Card (ignore if you are a new registrant) No Yes Life Rewards Card Number (if known)* Full Date of Birth dd 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31mm 01 02 03 04 05 06 07 08 09 10 11 12yyyy 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013  Year of Birth* Street Address* Suburb* State* Postcode* How did you find out about the Life Rewards Card Program* Coast Lifestyle Magazine From a Friend Life Gold Coast Magazine Radio Website Please indicate if you would like to receive updates via* Email SMS If you were refered to us by a current Life Rewards Member please tell us so we can reward them!* Register for* Life Rewards exclusive offers Life Rewards updates Monthly prize draw What's on Household Income* $100K plus $31K to $55K $56K to $100K up to $30K Gender* Female Male Interests* How many times do you travel annually* How many times do you dine out annually* * = required