Associate Member Application | Kentucky Restaurant Online Payment

Payment Details

This information is required

ASSOCIATE MEMBER APPLICATION DUES*

Price: $395.00

Subsidiaries

Check here if you have subsidiaries to your parent company that you would like to add. We will contact you for the information. Each additional listing is $65.00.

Subsidiaries*

Price: $65.00

Business Name

Contact Name*

First Last

Title*

Website

Email*

Phone*

Primary Address*

Street Address Address Line 2 City State ZIP Code

Hours of Operation Per Day*

Category*

Description Of Your Business To Be Used On The Website*

This information is required

To the Board of Directors: I submit my application for membership in the Kentucky Restaurant Association.

Signature*

Date*

Billing Address*

Street Address Address Line 2 City State ZIP Code

Secure Credit Card

Card Holder*

Card Number*

Card Expiration*

Card CVV*

Total

$0.00

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