Name __________________________________ Organization _______________________________
Address ____________________________ City ______________ State ______ Zip _________
Phone __________ e-mail address____________________________________________________
Please indicate, in blank, number of booths desired in your category of interest. Booth size 12’ X 12’. Limited electricity.
______Arts & Crafts
_______Food Booth _______Nonprofit
$35.00 per booth $75.00 per booth $125.00 No Charge unless
+ $15 for electricity Raising funds
Type of electricity____________
$1.00 per person park entry fee
Must be set up by 8:00 a.m., Saturday (No exceptions)
Product Description ______________________________________________________________________________
Mississippi State Tax number ______________________________
Alternate Tax status handled by Chamber of Commerce
Total Enclosed _________________________Make checks payable to:
Clarke County Chamber of Commerce.
Mail to P. O. Box 172, Quitman, MS 39355, no later than Wednesday, September 21st.