Contact Information: (*required) New or Renewal:  New   Renewal   *Contact Person: Title: *Restaurant Name (DBA): Corporate Name:  Street Address: Mailing Address: City:   State:   Zip: County: *Phone:  Fax: Best Time to Call: *Email: *Do you own or operate more than one location?  Yes   No --If yes, please fill out the information below -- Restaurant Name: Address: Phone/Fax: Restaurant Name: Address: Phone/Fax: Restaurant Name: Address: Phone/Fax: Seasonal Operation?  Yes   No If Yes, indicate dates of operation (month/day(:  thru
Membership Investment Schedule: Note: membership in MRA includes free membership in the National Restaurant Association Membership Dues: (based on annual gross sales of food and beverages)   $0 to $249,000 $   215 per year   $250,000 to $499,999 $   315 per year   $500,000 to $749,999 $   415 per year   $750,000 to $999,999 $   515 per year $1,000,000 to $1,999,999 $   675 per year $2,000,000 to $2,999,999 $   815 per year $3,000,000 to $3,999,999 $  1,015 per year $4,000,000 to $5,999,999 $  1,215 per year $6,000,000 to $7,999,999 $  1,415 per year $8,000,000 to $9,999,999 $  1,615 per year $10,000,000 to and up... $  1,815 per year Note: if sales are over $10,000,000, add $100 per million in additional sales   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