Mill & Main Dining Membership Registration

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Please fill out the form below to sign up for the Mill & Main Membership.

If you prefer to pay for the membership with check or card, please fill out CHECK or CASH in the credit card information section. You may email antonia@millandmainstreet.com for assistance or questions.

Email *

First Name *

Last Name *

Phone Number *

Email *

Birthday *

YYYY

Address *

Membership Selection

Weekender | $500 per year

Upstater | $1000 per year

Mill & Main Family | $1500 per year

Clear selection

Payment Method *

Credit Card / Debit Card

Check

Cash

Credit Card Number

(N/A if paying with CASH or CHECK)

Expiration Date

(N/A if paying with CASH or CHECK)

YYYY

Security Code

(N/A if paying with CASH or CHECK)

Billing Zip Code

(N/A if paying with CASH or CHECK)

A copy of your responses will be emailed to the address you provided.

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