URA MEMBER APPLICATION Company InformationCompany Name* Contact Name* Email Address* Phone*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Restaurant DetailsChef's Name Chef's Email Food & Beverage Director Food & Beverage Director's Email Type of Restaurant Primary Cuisine Amenities Banquet Room Liquor License Membership DuesGross Annual Income*$1 to $100,000$100,001 to $250,000$250,001 to $500,000$500,001 to $750,000$750,001 to $1,000,000$1,000,001 to $2,000,000$2,000,001 to $3,000,000$3,000,001 to $4,000,000 Renewal Total $0.00 Secure Credit Card Card Holder* Card Number* Card Expiration* Card CVV* Δ
