Highland Area Chamber of Commerce Annual Citrus Harvest

Highland Area Chamber of Commerce Annual Citrus Harvest Festival March 28, 2015
VENDOR APPLICATION
Return Application To: Highland Area Chamber of Commerce
PO BOX 455, Highland, CA 92346
(909) 864-4073 FAX (909) 864-4583 [email protected]
1. Name of Business or Group:
2. Contact Person:
3. Address:
4. Telephone:
FAX:
5. Email Address:
Website:
6. Permits Required With Application:
State Board of Equalization Permit No:
Highland Business License No:
Exp. Date:
Highland Special Event Permit
Non Profit Tax ID:
SB County Food Handlers Certificate/Health Permit
Insurance Certificate (Food Concessions & Activities Only) Naming Highland Area Chamber of Commerce
as additional insured
OR
7. VENDOR TYPE: Check one
Direct Sales
Food
Activity(Rock climb, car show, petting zoo, pony ride)
Nonprofit or Government Organization
Entertainment
8. Items to be sold or distributed. PLEASE INCLUDE PHOTO &/OR BROCHURE. Items not listed cannot be sold
9. Describe activity, demonstration, or entertainment to be provided:
FEES:
Direct Sales***************************************************** $80.00 (Chamber Members 25% off)
Food*********************************************************** $200.00
Nonprofit/Government Organizations****************************** $40.00
Activity/Entertainment (contact Chamber Office)*********************
Number of booths
X
Fees
=
Late FEE: add $15 if after March 9, 2015
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$
$
Total Amount
$
Highland Area Chamber of Commerce Annual Citrus Harvest Festival March 28, 2015
VENDOR APPLICATION
Return Application To: Highland Area Chamber of Commerce
PO BOX 455, Highland, CA 92346
(909) 864-4073 FAX (909) 864-4583 [email protected]
FEE Payment Information
Check Enclosed
Money Order Enclosed
Mastercard/VISA/Discover/Amex (please circle)
credit card number
expiration
CC ID#
PO number if applicable
Name on card
Billing Address Registered for this Card
City
State
Zip Code
HIGHLAND AREA CHAMBER OF COMMERCE CITRUS HARVEST FESTIVAL PERFORMANCE LIABILITY RELEASE
I, (print full name)_____________________________________________________fully understand that my participation in the
Highland Area Chamber of Commerce Citrus Harvest Festival (Hereinafter “special event”) exposes me to the risk of personal
injury, death or property damage. I hereby acknowledge that I am voluntarily participating in this event and agree to assume any
and all such risks.
I further acknowledge my likeness and image will be used for promotional purposes for this event. I agree to release all rights to
my likeness in support of all marketing and promotion.
I hereby release, discharge and agree not to sue The Highland Area Chamber of Commerce, and all event sponsors for any injury,
death or damage to or loss of personal property arising out of, or in connection with, my participation in the special event from
whatever cause, including the active or passive negligence of the Highland Area Chamber of Commerce, event sponsors and/or
any other participants in the special event.
In consideration for being permitted to participate in the special event, I hereby agree, for myself, my heirs, administrator s,
executors and assigns, that I shall indemnify and hold harmless the Highland Area Chamber of Commerce and all event sponsors
from any and all claims, demands actions or suits arising out of or in connection with my participation in the special event.
I HAVE CAREFULLY READ THIS RELEASE, HOLD HARMLESS AND AGREEMENT NOT TO SUE AND FULLY UNDERSTAND ITS
CONTENTS. I AM AWARE THAT IT IS FULL RELEASE OF ALL LIABILITY AND SIGN IT ON MY OWN FREE WILL.
Signature (Legal Parent/Guardian signature if under 18 years of age)
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