Membership Form PRE-FIX - ANNUAL MEMBERSHIP PLANA LA CARTE - ANNUAL MEMBERSHIP PLAN Annual Membership Plan 2021 Full Payment ($600) must be paid in full online by TBD Mail two (2) $25 gift cards or certificates to Little Venice by TBD . 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*Please 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 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Δ A La Carte 2021 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 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Δ
