GOLD CARD HOLDER Registration – Discounts Health Service

Personal Email (required)*

Title: (required)*

Your Name (required)*

First Last

Your Home Address incl postcode (required)*

Street Address City County Postal code

Your mobile number (required)*

Your Gold Card No (required)*

Who issued you the Gold Card and the date you received it (required)*

RECOMMENDATIONS: List names of businesses you would like discounts from (Restaurants, Hairdressers, Solicitors, etc. e.g., Aagrah Restaurant, Shipley)

Date of Birth (required)*

DISCLAIMER:*

DISCLAIMER: You must fill in all the required fields when registering. You confirm that the information entered is true. Upon verification, if the information you have provided is found to be incorrect for whatsoever reason, we reserve the right to cancel your password forthwith and refuse you access to DiscountsHealthService.com. In the event, the password is cancelled, your submitted details will them be deleted from our database and treated as if they never existed.

Check here to indicate that you are agree and have read the disclaimer

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Password

Your temporary generated password will be emailed to you upon approval. You will be able to change it to a password of your choice.