Contact Information: (*required) New or Renewal:  New   Renewal   *Contact Person: Title: *Business Name: Corporate Name:  Street Address: Mailing Address: City:   State:   Zip: County: *Phone:  Fax: Best Time to Call: *Email: Primary Business:
Membership Investment Schedule: (Dues are based on annual gross sales)   under $2 million $   325 per year                              over $2 million $   450 per year You must select one of the dues levels above and enter the dues amount in the field below: Dues Amount: $  (do not enter $ or commas) Comments:
Credit Card Information:  Card Type: VISAMasterCardAmExDiscover  Name on Card:  Card Number:  Expiration Date: JanFebMarAprMayJunJulAugSepOctNovDec / 20032004200520062007200820092010 Amount Charged:
If paying by check, make check payable to Michigan Restaurant Association, and mail to: Michigan Restaurant Association; 225 West Washtenaw, Lansing, MI  48933; Phone: 800-968-9668 or 517-482-5244; Fax: 517-482-7663