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Domestic Violence Walk/5kRun
Vendor Registration Form
Saturday, October 23, 2010
Idlewild Park, Easton, Marlyland
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Please plan to be at the event by 8:00am to set up.
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Organization Name:
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Contact Name:
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Contact Email
Address:
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Street Address:
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State:
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Zip:
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City:
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Phone Number:
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Please Indicate any
Special Needs?:
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There is a $50.00 Vendor table fee. You may pay online via Paypal (click here)
or Mail your check to:
Witney's Lights
P.O. Box 1609
Dover, DE 19903
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I will mail a $50 check to the above address
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I will submit a $50 payment via Paypal
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Can you provide promotional items/materials that can be
added to participant goodie bags.?
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yes
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no
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If yes please indicate the
type of items/materials to
be provided:
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Print a copy of this form for your records prior to clicking the submit button. We look foreward to seeing you on October 23rd!
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Waiver: In submitting this entry, I am intending to be legally bound. On behalf of myself, my heirs, executors
and administrators, I hereby waive, release and forever discharge any and all rights and claims which may
hereafter occur to me against Witney’s Lights, Inc., all sponsors, directors and volunteers from any and all
claims, injury or actions sustained or suffered in connection with my participation in the event. I hereby grant
full permission to all of the above to use my name, likeness and photographs for any publicity and promotional
purposes without obligation or liability to me. I understand that the streets along the course will reopen at the
discretion of the City of Dover Police Dept. and will abide by their direction.
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