The Building of South Middle River KABOOM - November 1, 2018

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

You may also pay with Zelle: Open the banking app on your phone and use Zelle to send your payment to info@centralcityalliance.org

Name *

First

Last *

Last

Neighborhood

Lake Ridge

Middle River Terrace

Poinsettia Heights

South Middle River

Select Membership Price *

25 Personal

50 Business

100 Neighborhood Association

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 *

Check

Zelle

Please send your check to:
Central City Alliance C/O Barry Curtis
1525 NE 5th Avenue
Fort Lauderdale,FL 33304
Make checks out to Central City Alliance

Please open the banking app on your phone and use Zelle to send your payment to info@centralcityalliance.org.

If you are human, leave this field blank.

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.

Thanks Jetblue, for providing kids in community this wonderful playground. Thanks to the employees and all the wonderful volunteers that came in on this day to help build the Kaboom.

Please rank your priorities

Vendor Application: June 13th on 13th Street

Contact Person

The Building of South Middle River KABOOM – November 1, 2018