Company Name:

Artist Name:

Address:

City, State, Zip:

Phone #:

Cell # : 

Fax #:

Email : 

Website : 

Artist Format :  Indicate the format of your artwork, and give a brief description of what you will be featuring at the festival.

Description :  Give a brief description of what you will be selling at the festival, include pricing information.

Raffle Item:

Value:

One eight foot space : 

$99 (1 table & 1 chair)

Two eight foot spaces : 

 $175 (2 tables & 2 chairs)

Three eight foot spaces : 

 $275 (3 tables & 3 chairs)

 $150 (10' x 10' tent, optional)

 $15

Extra Chairs:

 x $5 each

Please indicate your signature by typing your name in the box below.

Signature : 

Card Type : 

Visa MasterCard Discover

Name on Card

Credit Card # : 

Expiration : 

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