| Your Name(s): ________________________________________________ |
| Business Name: _______________________________________________ |
| Mailing Address: ______________________________________________ |
| City, State & Zip Code: __________________________________________ |
| Phone: ________________________________________________________ |
| |
| Describe basic merchandise and/or theme: |
| ___________________________________________________________________ |
| ___________________________________________________________________ |
| ___________________________________________________________________ |
| |
| Space Requirement: _________ 10X10: _________ 20X10: _________ 20X20: _________ |
| Extra # souvenir button @ $4.00 each: _________________________________ |
| Amount: _______________________________________ |
| Special Needs: ____
Electricity in Booth Space @ $5.00 per weekend
|
| Other: _______________________________________ |
| Motor Home/Camper size: _______________________________________ |
| |
Tri-County Antique Club assumes no responsibility for loss of property, or personal injury, or any manner in which loss occurs, whether to person or property.
|
| |
| Enclosed: |
| Cost of Space (1/2 down required)__________ Balance Due__________ |
| Electricity in Booth__________ Extra Buttons__________ Total__________ |
| |
| Signature:_______________________________________________ |
