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MEMBER REGISTRATION FORM

Gold Member Registration Form:
Region: Area:
First Name*: Last Name*:
Restaurant Name*: Address*:
City: Postal Code:
Phone*: Email:
Cuisine**: Other Type:
Fax: Web Site:
Your customers' payment options:
Cash MasterCard Visa American Express
Ambience:
Casual Country Style Dim Lights Elegant
Family Festive Formal Fun
Great Views Music Party Quiet
Romantic Well Lighting
Features:
Award Winning Banquet Bar Bed & Breakfast
Breakfast Brick Oven Brunch Buffet
Business Lunches Cash Only Celebrities Celebrity Owned
Coffee Cyber Cafe Dancing Delivery
Dinner Theater DiRoNA Early Bird Special Fireplace
Game Menu Garden Hotel Dining Kid-Friendly
Light Menu Microbrews Off-Premise Catering Open Late Night
Outdoor Dining Parking Pre-Theater Menu Private Parties
Pub Raw Bar Reservations Salad Bar
Senior Discount Singles Sushi Bar Take Out
Tasting Menu Theater District Wheelchair Access Wine Tastings
Business Hours:
Monday Tuesday
Wednesday Thursday
Friday Saturday
Sunday
Description:
I would like to pay by:
Credit Card    Cheque
Check Code:  
Please type the number into the box.
*required     **CONTROL key for multiple select.


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