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         _______Trades               _______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.