Central City Alliance

Members Area

This page is for members.

Membership

If you prefer to submit by mail, please click here to print a copy of this form.
You may send the completed form with your payment to payments@centralcityalliance.org, or send by
mail to:
Central City Alliance C/O Barry Curtis
1525 NE 5th Avenue
Fort Lauderdale,FL 33304
Make checks out to Central City Alliance

Name *

First

Last *

Last

Select Membership Price *

100

select 25 for personal membership, 50 for a business, 100 for an association

Organization or Company Name

Phone *

Email *

Address *

Address

City

State/Province

Zip/Postal

Comments

Payment *

Paypal (no account needed; you may pay by credit card)

Check

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Donation

If you prefer to donate by mail, please click here to print a copy of this form.
You may send the completed form (or just a note) with your payment to payments@centralcityalliance.org, or send by
mail to:
Central City Alliance C/O Barry Curtis
1525 NE 5th Avenue
Fort Lauderdale,FL 33304
Make checks out to Central City Alliance

Name *

First

Last *

Last

Organization or Company Name

Phone *

Email *

Address *

Address

City

State/Province

Zip/Postal

Specify Purpose of Donation *

Donation Amount *

Comments

Enter any additional comments

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Vendor Application: June 13th on 13th Street

Business Name *

Contact Person

Name

First

Last *

Last

Phone *

Email *

Social Media URL

Website URL

What is the nature of your business?

Anything else you would like us to know?

Please tell us who referred you to us

Please note that selected vendors are responsible for their own tent and set up. Vendors may set up between 11 am and 12 pm.

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