Meet Me Wednesdays Register

Name of Restaurant/Business*

Address*

Street Address City State ZIP Code

Business Phone Number*

Contact Name*

First Last

Contact Title

Contact Email*

Contact Phone*

Participation*

If you have selected "Meet Me", please tell us how you wish to provide your monthly $25 gift certificates for our free raffle.

Specific Details of Discount. If you are providing gift cards, tell us how/when you will get them to us.*

Comments? Questions?

Phone

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