Restaurant Registration

Restaurant Name:*
Contact Name:*
Contact Title:*
Contact Email:*
Contact Number:*
Restaurant Address:*
Website:*
Offering $20 3 course lunch?*
Offering 3 course dinner?*
Have you emailed or mailed your 5 gift certificates for a Flavor dinner for 2? P.O. box 14131, North Palm Beach, FL 33408
Photos:

Please upload photos of chef, interior, exterior, or flavor menu items.

Menu Upload:

Please include your restaurant name in the file name. PDF files only.

Payment:*
$950 per restaurant. If paying with PayPal you will be redirected altering submitting this form.

If sending a check please make payable to: Flavor Palm Beach and mail to PO box 14131, North Palm Beach FL 33408?

NOTE: The benefits of your participation will be activated upon acceptance of payment.

Check number (if paying by check):

I acknowledge that by agreeing to participate in FLAVOR Palm Beach, my restaurant will adhere to all required guidelines as outlined herein. I acknowledge my restaurant will pay the participation fee, provide the necessary gift certificates for promotional purposes, accept reservations, and utilize the FLAVOR Palm Beach menu ON PROVIDED TEMPLATE during the month of September. Failure to abide these guidelines may result in a dismissal from the promotion and forfeit of participation fee. Subject to changes and availability.

Authorized By:*
Date:*
Email:*
Word Verification: