Restaurant Week Registration Form

2. Restaurant Name*
4. Address of Restaurant*
6. City*
7. State*
8. Zip Code*
10. Business Phone Number*
11. Restaurant Website Address*
13. Contact Name for Restaurant Week Coordination*
14. Contact Person Phone Number*
16. Contact Person Email Address*
18. Rules and Guidelines:
    *Menu Items must be equal portion size to the current menu. *Restaurant must have a pre-fixe meal available for the week breakfast, lunch, or dinner. *Restaurant Menu Items must stay consistent throughout the entire promotional period of April 20-26, 2020. *Restaurants are to provide a PDF version of their Restaurant Week menu to be posted on their restaurant website and the Town website. *Restaurants must donate a $25.00 gift card to the Town of Mount Airy to be used leading up to or during the event for promotion of Restaurant Week.
20. I read the Rules and Guidelines listed above and will follow them as written. *

    1. Yes
22. Registered participants Toolkit includes:
    Official Campaign Poster, Table Stands, Advertisement Check Stuffers, Pens, Children’s Coloring Pages with Crayons (Only to those restaurants who would find this useful), Digital Media Kit Logo
24. Will you be wanting Children's Coloring Pages with Crayons?*

    1. Yes
    2. No
26. For each Breakfast, Lunch or Dinner that is offered, Restaurant Week participants are required to offer a minimum of two courses. I agree to offer prix fixe menus for the promotion rates of:
28. Breakfast*

    Choose all that may apply.

    1. $10
    2. $15
    3. $20
    4. $25
    5. $30
    6. $40
    7. I will not be offering a prix fixe breakfast menu.
30. Lunch*

    Choose all that may apply.

    1. $10
    2. $15
    3. $20
    4. $25
    5. $30
    6. $40
    7. I will not be offering a prix fixe lunch menu.
32. Dinner*

    Choose all that may apply.

    1. $10
    2. $15
    3. $20
    4. $25
    5. $30
    6. $40
    7. I will not be offering a prix fixe dinner menu.
34. What's next?
    Create your prix fixe menu and email a PDF or JPEG to [email protected]. You will soon be contacted about promotional products and sent a media kit. Thank you for joining in 2020 Mount Airy Restaurant Week!
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field