APPLICATION FOR 2011 WHITEMARSH ENCAMPMENT – SUTLER

By submitting this agreement, I agree to the $30 Event Fee, payable to the Friends of Hope Lodge. Payment due no later than November 5, 2011.

Whitemarsh Encampment 2011
Hope Lodge Historic Site
553 South Bethlehem Pike
Fort Washington, PA 19034

Name of Business
Owner
Mailing address
Phone
Fax
Email
Participation, November 5 and 6, 2011	Sat. & Sun. Saturday only Sunday only
Participants (approx.)
Type of goods sold
Tent size (height, width, depth, measured stake to stake
Frontage
I am willing to provide a talk, demonstration, or presentation
I am willing to repeat the talk, demonstration, or presentation
Special requirements or needs
Liability insurance with a combined single limit of $1,000,000 for bodily injury and property damage is required for your participation in the 2011 Whitemarsh Encampment Re-enactment. Please mail your certificate to the address below.
Insurance company
Certificate number
I accept the Rules and Regulations