ONLINE REGISTRATION

VENDOR APPLICATION JUNETEENTH CELEBRATION

Sunday, June 19, 2011 – 1:00—5:00 pm

Merchant Vendors $25.00* (Can be paid on the day of the event).

Food Vendors $75.00 (includes health permit)* Must be paid in advance.

CHECKS SHOULD BE MADE OUT TO: IMANI PRAISE FELLOWSHIP

Non-profit Vendors are FREE (no selling permitted.)

Standard space is 10X10. Optional fee of $25 includes 1 Table and 2 Chairs

Company/Organization Name

Address*

Address 1

Address 2

City

State

Postal Code

Country

Phone number*

Fax

Contact Person*

First

Last

Contact Person Phone Number*

Email*

Type of booth:*

Non-Profit

Merchant Vendor

Food Vendor

Seller's Permit Number

Health Certificate Number (Mobile Food Vendor)

FOOD VENDORS: What type of food will be sold. (Please no pork, shellfish, or catfish).

EXTRAS:

Optional Table and Chairs ($25 for 1 table and 2 chairs)

Additional space ($75 for additional 10x10 space)

All vendors (including non-profit vendors) must have a business license in Moreno Valley. For Moreno Valley businesses, this license can be obtained by the city for $57. If you are a non-profit business in Moreno Valley, this fee is waived if you have proof that you are a 501(c)3. Download the form here.

If your business is not located in Moreno Valley, a one-day permit can be obtained for $5. This fee is in addition to the Vendor fees.

My business is not based in Moreno Valley. Please obtain a $5 permit for me.

Terms and Conditions:*I AGREE to defend, indemnify and hold harmless Imani Praise Fellowship from and against all injuries, whether personal or real, claims, damages, losses, judgments, liabilities, expenses and other costs including litigation costs and attorney’s fees arising out of, resulting from or in connection with any negligent act or omission by myself or my employees or agents in providing services and/or goods at the Imani Praise Fellowship Juneteenth Celebration. I certify that I am responsible for the activity and am authorized to: 1) execute on behalf of the group or business, 2) accept legal process on behalf of the business or group.

I have read and agree to the terms and conditions.

Please type your name for electronic signature, indicating you have read and agree with the above terms.*

Vendor Application