Please enroll me in the Roosevelt Wine Club at Elk Cove Vineyards. I understand that I may cancel my membership after two shipments.

I certify that I am 21 years or older.

(fields marked with an * asterisk are required)

*Birth date (mm/dd/yyyy)

*First and last name

*Email address

Shipping name (if different from name given above)

*Shipping address

*City, State, Zip

*Billing address

*City, State, Zip

*Daytime telephone number (area code first)

Evening Telephone Number (area code first)

We do not take credit card payments online and will contact you for your credit card information.

As shipping laws are constantly changing, we will contact you to discuss whether we can ship into your state.

If you have questions, please call Martha Wagner at (877) ELK-COVE or locally at (503) 985-7760.