Peel off the bar card tags.
Fill in with a fictitious name or don't fill it in at all. Just throw it out.
Don't give your address. Don't give your phone number. Don't give your e-mail. Don't give your freep name.
When you check out, pay cash. No check, no credit card, no bar coded coupon mailed specifically to your address.
If you want to be really hostile, ask for a fresh application each time you enter the store and throw it away, cards and all, when you leave.