Welcome to Mica

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Personal Details

Card Number

To register a pre-printed membership card, enter the number as printed on the card here or scan the cards QR code.

Title:

Gender:

First Name/Given Name: *

Last Name/Family Name: *

Date of Birth: *

ID Number:

Passport Number:

Country of Issue:

Expiry Date:

Favourite Mica Store*

Referring Account Number:

Postal Address:

Country: *

Province/State: *

City/Town: *

Area/Locality/Suburb: *

Pin Code/Zip Code: *

Address Line 1:

Address Line 2:

Contact Details

Mobile Number: *

Number*

Home Number:

Number

Work Number:

Number

Email: *

Re-enter Email: *

Communication Preferences

Receive Notification of Account Changes via ?

Receive Mica Newsletter via ?

Receive Promotions from Mica via ?

Receive Promotions from Mica Partners via ?

Receive Statements via Email?

Additional Details

Please specify a password with a minimum of 6 characters and a maximum of 16 characters containing at least 1 lower case character, 1 upper case character, 1 numeric value and 1 special character.

Password: *

Verify Password:*

PIN Number: *

Your PIN number is used as an authentication method for redeeming your points at the Point of Sale.

Security Question:*

Answer:*

I agree to receive a confirmatory copy of these terms & conditions on my registered email