Restaurant Registration

Restaurant Name:*
Contact Name:*
Contact Title:*
Contact Email:*
Contact Number:*
Restaurant Address:*
Offering $20 3 course lunch?*
Offering 3 course dinner?*
Are you on OpenTable?:*
Please upload your menu:
Select Payment Type:
Payment Type:
$950 per restaurant. If paying with PayPal you will be redirected after 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. Deadline for payment and vouchers is May 31. Your Flavor menu is due July 15.

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:*
Word Verification: