Already have a Daisy Club Card?You are all set! No need to register here. This form is only for brand new Daisy Card requests.Name* First Last Email* Phone number (xxx-xxx-xxxx)*Preferred TERRA Location*Choose TERRA locationBurlingtonHamiltonMiltonWaterdownVaughanHow Did Your Hear About The Daisy Club?*Choose applicable optionFacebookInstagramIn storeBrowsing WebsiteOtherAddress* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code * By providing your email address, you are agreeing that you will be added to the TERRA mailing list. CAPTCHA Δ
