Earn 1 point for every $1 spent.

* an asterisk denotes a required field
First Name * Last Name *
Street Address * Apt / Suite / etc
City * State * Zip Code *
Email Address *
Confirm Email Address *
Phone Number or Numbers *
Can be used in place of a physical card
at the time of purchase.
Number of People in Household *
() -
() -
() -
Birthday * Wedding Anniversary
/ / / /

Spouse's First Name Spouse's Last Name
Spouse's Email Address
Confirm Spouse's Email Address
Spouse's Birthday
/ /

Referral Code (Office Use Only)
Clerk Number (Office Use Only)
We are firmly committed to your privacy and the protection of your information. We will NEVER share, sell or rent individual personal information with anyone without your advance permission.
The emails you receive from us will include regular email communication notifying you of special offers, events, point balances, and promotions, sent to you on behalf of Lakeside Restaurant & Cantina from Empower Marketing (@myrewardsprogram.net).
Privacy Policy

Once submitted, your Phone Number serves as your card number.
***No card necessary***