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Membership Application

For your convenience a printable form is available in Adobe PDF format for printing and mailing.

A free PDF plug-in for your browser
is available from Adobe Systems.

Fields marked with * are Required.
*Business Name: *Date:
Corporate Name: Referred By:
*Primary Contact and Title:
*Physical Address:
*City: *State: *Zip:
Mailing Address:
City: State: Zip:
Website: *Phone: Fax:
E-Mail: MeRA will ONLY communicate via email regarding time-sensitive updates and alerts. We will not use email for any standard commun ications unless specified by you. MeRA does not share email information with any outside organizations, it is for internal purp oses only. Please help us to assist you by sharing your email information with us.
Do you own additional properties? Yes No If yes, please list additional properties:
Please send me more information about: ServSafe Safe Food Handling Certification Diner's Choice® Woker's Comp Insurance Reduced-Fee Credit Card Processing Restaurant & Lodging Expo

2004 - 2005 MeRA / NRA Dues Investment

Restaurant Member dues are based upon annual gross sales of all food and beverages.
Please check the category which applies to your operation.

Restaurant Membership
Form of Payment
Up to $200,000
$215.00
$200,000-$350,000
$270.00
$350,001-$500,000
$320.00
$500,001-$750,000
$380.00
$750,001-$1,000,000
$430.00
$1,000,000-$1,250,000
$490.00
$1,250,001-$1,500,000
$535.00
$1,500,001-$1,750,000
$595.00
$1,750,001-$2,000,000
$645.00
Each Additional $500,000 in sales, please add
$50.00
Multiple Unit Companies 
Per additional unit
$135.00

Largest volume unit at regular
membership fee.

Make Checks Payable to:
Maine Restaurant Association
5 Wade St. - PO Box 5060
Augusta, ME 04332-5060
Check VISA M/C
Amex Discover

  Card #
  Exp. Date
  Amount $:

I authorize the above charges to my credit Card.

The applicant affirms that the business they represent is operating in conformance with recognized standards and accepted business practices of the restaurant and hospitality industry.

Note: 25% of the dues assessed on this application are not deductible for Federal Income Tax purposes under section 162 (E)(2) as they are allocable to lobbying activities to benefit the Food Service Industry of Maine.

Maine Restaurant Association, 5 Wade Street, PO Box 5060, Augusta, Maine 04332-5060
phone: 207-623-2178  fax: 207-623-8377 e-mail: [email protected]