Name of Vendor/Exhibitor (Promiser)

Company Name

Email

Phone Number

LIST ALL items for approval for Fuerza Latina - Item #21 above

MUST provide a $2M Certificate of Insurance, listing Town of Bradford as additional insured, OR purchase a Certificate of Insurance for only $23.00 directly from the Town of Bradford (link below) MUST provide a $2M Certificate of Insurance, listing Town of Bradford as additional insured, OR purchase a Certificate of Insurance for only $23.00 directly from the Town of Bradford (link below) Yes

I agree to the terms and conditions above and have fully read the document I agree to the terms and conditions above and have fully read the document Yes

Signature

Date

Cost: $200.00 booth space for small entrepreneurs - Full payment required Cost: $200.00 booth space for small entrepreneurs - Full payment required

Cost: $650.00 booth space for one representative of a Corporation, plus $200.00 for each additional representative - Full payment required Cost: $650.00 booth space for one representative of a Corporation, plus $200.00 for each additional representative - Full payment required

There is an additional late fee of $50.00 There is an additional late fee of $50.00