Business Name

Business Address

Business Type (gallery, restaurant, retail, etc)

Business Description (will be posted publicly):

Business Website (optional)

Business Instagram (optional)

Business Facebook (optional)

How would you prefer to pay your $25 annual dues? How would you prefer to pay your $25 annual dues? I will use the payment link at the end of this form (appears after formsubmission) I will drop off cash/check in person at 78 Allen Street Email me a payment link Text me a payment link

Your Name

Email Address

Phone Number (optional)

Your Title

Secondary Contact Name (optional)

Secondary Contact Title (optional)

Any Additional Comments, Questions, or Concerns (optional)

Membership Commitment Membership Commitment By submitting this form, I affirm that the information provided in this application is accurate and complete to the best of my knowledge.

Membership Commitment (2 of 5) Membership Commitment (2 of 5) I understand that Full Membership is exclusively available to businesses within the designated boundaries of the “Shop Allen Street” Block Club, predicated on adherence to the bylaws and objectives of the Block Club, as well as the commitment to contribute positively to the collective goals of the business community within the designated area.

Membership Commitment (3 of 5) Membership Commitment (3 of 5) I acknowledge that each Full Member Business is entitled to one vote at general membership meetings, and that up to two owners or key staff members from each Full Member Business are permitted to attend applicable meetings and may be nominated for positions within the organization.

Membership Commitment (4 of 5) Membership Commitment (4 of 5) I understand that Full Member Business annual dues are set at $25, intended to cover administrative expenses and demonstrate commitment to the success of the block club. These dues are payable immediately via cash or check submitted with this application (or I will submit right now using the QR code at the end of the application) and that dues will recur annually every January for so long as my business is a member of the block club.

Membership Commitment (5 of 5) Membership Commitment (5 of 5) I understand that Full Membership will give me promotional opportunities and I give permission to use my businesses' name & logo on the "Shop Allen Street" website and promotional materials.