Domaine Serene Interest Form *First Name *Last Name Address Address 2 City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Phone *Email Opt into mailing list What are your wine preferences? Pinot Noir Chardonnay Sparkling Wine French Wine Oregon Wine No Preference/Not Sure Other Are you interested in learning more about our wine clubs? Yes No Other Leave this field blank: Submit