URA MEMBER APPLICATION Company InformationCompany Name*Contact Name*Email Address* Phone*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Restaurant DetailsChef's NameChef's Email Food & Beverage DirectorFood & Beverage Director's Email Type of RestaurantPrimary CuisineAmenities Banquet Room Liquor License Membership DuesNormally, membership dues are determined by gross annual income. During this difficult time, we invite you to determine your own dues with a suggested investment beginning at $200 per location. We are grateful for your support.* Renewal Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name
