Vendor Application

Vendor Application
Name *

First Name Last Name
Email
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
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:
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