NM Wine Membership Application Form

New Mexico Wine

2023 Membership Application
Name of Winery and/or Vineyard*
Main Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Website
Logo

Browse Files
PDF, JPG, PNG Cancelof
Owner Name
Wine maker name
Phone Number

Area CodePhone Number
E-mail
Facility Information check all that apply

WineCiderBeerSpiritsTasting RoomPatio or Outdoor SeatingMusicBed / BreakfastFull Service RestaurantSimple Food OptionsVineyardOrchard
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Membership - 1 year$125.00

Subtotal $0.00Tax $0.00Total $0.00
Should be Empty:

New Mexico Wine