Player’s Club Card Application

Simply fill out the form and bring it to the Gift Shop at Plainridge or to apply by mail, send the completed form to:

Plainridge Racecourse

301 Washington Street

Plainville, MA 02762

Your card will be ready the next time you visit the facility.

Name: __________________________________

Mailing Address: _________________________

________________________________________

City: ____________________________________

State/Zip: _______________________________

Phone: __________________________________

Date of Birth: ____________________________

Social Security #: _________________________

Driver’s License No.: ______________________

State of issue: ____________________________

E-Mail: _________________________________

Winline Account # ________________________

Signature: _______________________________