dineLA Restaurant Week 2009 Registration

RESTAURANT INFORMATION
Please enter restaurant information as it will appear in dineLA Restaurant Week marketing materials.

Restaurant Name

Restaurant Address

Restaurant Phone Number

Website Address

American Express Merchant Number		 If you don't already accept the American Express Card, call 888-829-7302 Mon-Fri 8:30am-8pm EST to sign up today.
 
CONTACT INFORMATION
Please provide ONE person who will serve as the main contact during dineLA Restaurant Week.

Contact Name

Contact title

Contact Email
Contact Phone Number
 
REGISTRATION FEES & PAYMENT
    Deluxe Dining Level - $16 Lunch / $26 Dinner $600 Per Restaurant
    Premier Dining Level - $22 Lunch / $34 Dinner$800 Per Restaurant
    Fine Dining Level - $28 Lunch / $44 Dinner*$1,000 Per Restaurant
*subject to dineLA approval based on existing menu pricing.
     Pay Credit Card: American Express, MasterCard, Visa
To pay by credit card, please click here to download the credit card authorization form, complete and fax back to 949.200.7029.
      Pay By Check: Make check payable to:
LA INC. The Los Angeles Convention and Visitors Bureau
Mail check with a copy of your confirmation email to:
2700 E. Coast Hwy, Suite #6
Corona del Mar, CA 92625
Event Registration Deadline is Friday, November 14, 2008
 
MENU SELECTIONS
Please check the selected dining level for the menu listed below
Lunch / Dinner