Vendor Application

Name *

First Name Last Name

Email

example@example.com

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Resale ID#

Description of Merchandise to be Sold:

By Submitting this application you are agreeing to the following: I agree to be solely responsible for any costs, claims, damages and expenses incurred as a result of my participation in the Twain Harte Rotary Crapper Derby. I also understand that I am participating in the event at my own risk. In the event of any loss or injury sustained from participating in the aforementioned event, I hereby agree to defend, indemnify and hold harmless, release and forever discharge Twain Harte Rotary Club and all businesses, the promoters, sponsors, employees and agents of this event from any lawsuits or demands from any organization based on my participation in this event.

Name:

Date: