Sign up now to join the Pembroke Mall Birthday Club! Receive a coupon in the mail for a FREE Kids Meal at participating restaurants for your Birthday. Also, be the first to be invited to all the fun and exciting Club activities throughout the year. Kids 12 and under.

*Child's First Name

 

*Child's Last Name

 

*Birth Date

 

*Address

 

*City

 

*State Select State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VA VT WA WV WI WY

 

*Zip

 

Phone Number

 

*Parent's First Name

 

*Email

 

Enter the text in the image   

 

  

 

Powered By ChronoForms - ChronoEngine.com

Pembroke Mall will be using this registration to form a database to send you valuable information and special sales. If you wish to unsubscribe, please click here This e-mail address is being protected from spambots. You need JavaScript enabled to view it . To unsubscribe by postal mail, please send your request to: Pembroke Mall, 4554 Virginia Beach Boulevard, Suite201, Virginia Beach, VA 23462.