Membership Form PRE-FIX - ANNUAL MEMBERSHIP PLAN 2019A LA CARTE - ANNUAL MEMBERSHIP PLAN 2019 Annual Membership Plan 2019 Full Payment ($600) must be paid in full online by February 8, 2019 Mail two (2) $25 gift cards or certificates to Little Venice by February 8, 2019. Gift card will be used throughout the year for marketing purposes. Please make sure gift cards are valid for one full year. Late payments will NOT be accepted and by default must go A La Carte. Any outstanding payments may jeopardize eatBing membership. Restaurant Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Email* Website* Restaurant Description*Restaurant Hours*Social Media LinksPlease select all events you would like to participate in. Price will not change based on which/how many events you attend.Full CostEvents*Please select all events you would like to participate in. Price will not change based on which/how many events you attend. Spring Restaurant Week Fall Restaurant Week Wine & Tapas Martini Walk Beer & Bites Small Business Saturday CTA Hello Binghamton Book Discount ✔Any New Event in Calendar Year FREEGift Cards Donation for Promotional Use Required: You will need to mail two Gift Card from your business in the amount of $25 each upon submission. $25.00Promoted on social media all year ✔Featured on website all year ✔Featured on any additional print marketing ✔Opportunities to be promoted on local media ✔Representation at University Fest ✔Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name A La Carte 2019 Restaurant Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Email* Website A La Carte Membership Plan (Select)* Spring Restaurant Week Fall Restaurant Week Wine & Tapas Martini Walk Beer & Bites Small Business Saturday Product NameGift Card Donation for Promotional Use Required: You will need to mail a Gift Card from your business in the amount of $25 upon submission. $25.00Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name
