| 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: ____ Fire in Booth Space, Water, etc. |
| Other: _______________________________________ |
| Motor Home/Camper size: _______________________________________ |
| Electricity - $5.00/weekend : ________ Yes ________ No |
| |
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.
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| Signature:_______________________________________________ |
