DEADLINE FOR ENTRY SEPTEMBER 15, 2010

You may mail, fax or email this entry form: Mail to: Louisburg Cider Mill, 14730 Hwy. 68, Louisburg, KS 66053 or, Fax to: (913) 837-5762.  This form can also be accessed on our website’s home page. Just look in the red banner towards the bottom of the home page at www.louisburgcidermill.com. Then send the completed form to our email: lcmill@mokancomm.net.     

NAME:                                                                                                                                   

ADDRESS:                                                                                                                            

CITY, STATE, ZIP                                                                                                                

PHONE #:                                                                                                                             

EMAIL: ______________________________________________________________________

BRIEF DESCRIPTION OF DISPLAY:                                                                               

I will need__________10 foot space(s) (see first page for costs).  Booth spaces are assigned on a first paid, first served basis.

I need to work from my vehicle.  __________no   _________yes         (Limited space available,

Size of vehicle_______________________                                     restrictions apply.)

I need electricity.  _______ ($30 per weekend enclosed) 

Check desired dates:  Sept. 25^th & 26th______ Oct. 2^nd & 3rd ______   (Note: We cannot split weekends)

Payment Method:       □Check □MasterCard □Visa □Other 

                                    Card #:                                                                         Exp. Date:            

                                    TOTAL AMT. PAID:  $                              Check #:                                              

RELEASE AND WAIVER OF CLAIM: I agree that the Louisburg Cider Mill, Inc. is in no way responsible or liable for any damage or loss of any kind to my personal property or being during the events on September 25^th & 26^th, 2010, and/or October 2^nd & 3^rd, 2010.

All federal, state, and local laws governing retail sales tax must be followed. I understand the rules and regulations of the show and will comply. I realize that failure to comply may result in expulsion from the show.

EVENT WILL TAKE PLACE RAIN OR SHINE. ENTRY FEES ARE NON-REFUNDABLE. VENDORS ARE REQUIRED TO REMAIN SET UP UNTIL 6 P.M. EACH DAY.

MUST BE SIGNED BY VENDOR                                                    DATE

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Cider Mill use only

Date Received                                                          Amount Received $                                

Check #: