Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Electricity needed for both? *

Please bring extension cords as needed as electricity may not be available directly in your booth

Yes

No

I will be submitting my payment via *

Check, Money Order, or Cashier's Check

Paypal

I have read and understand the rules and regulations (https://docs.google.com/document/d/1aOv5ydqzJE-FPH4tVnmnMve5FK891NDVEmY-kHWHaMk/edit?usp=sharing) to participate in the 2019 Midlothian Village Day Festival and Craft Fair) *

Yes