TRI-CITIES MAIN STREET MEMBERSHIP FORM
Mail to:

Tri-Cities Main Street
PO Box 513
805 E. Main ST
Cumberland, KY 40823

NAME (PRINT CLEARLY):____________________________________________________

ADDRESS: _______________________________________________________________

CITY & STATE: ____________________________________________________________

ZIP & PHONE: ____________________________________________________________

E-mail: _________________________________________________________________

NTHP Source #4M1397

Check Preference for Membership Level

____ Mainstreeter $25.00*

___ Supporter $50.00

___ Downtowner $100.00

___ Contributor $250.00

___ Champion $500.00

___ Patron $1,000.00-$2,499.00

___ Leadership $2,500.00-$4,999.00

___ Partner $5,000.00-$20,000.00+

___ Check Here if you want to volunteer with our program.

*Businesses may not apply at this level. The Mainstreeter level of membership
is only valid for individuals and residents. The minimum
business membership is $50+.

If you have questions call Terina Collins at 589-5151.