Flea, Craft & Antique Market Registration Form

Momence, Illinois         August 8-9, 2009

Name _______________________________  Phone __________________   E-mail ____________________

Street ________________________________ City _______________  State _____  Zip _________

Type of Vehicles & Equipment to be placed in vendor Spaces

Check all that apply and give brief descriptions

____ Car ____________          ____ Van (mini or full size; give height)________________________________________

____ Pickup__________          ____ Pickup w/ cap or box (give height)________________________________________

____ Delivery or Cube Van or Truck (give height & length)__________________________________________________

____ Motor Home (give height & length) ________________________________________________________________

____ Pulled Trailer or Camper (give height & length)________________________________________________________

____ Tent or Canopy (give dimensions)___________________________________________________________________

Type of Merchandise for Sale

Briefly describe your merchandise: ___________________________________________________________________________________________

________________________________________________________________________________________________________________________

Vendor Fees (non-refundable)

__ Saturday only       __ Saturday and Sunday  (space fee applies for one day or both days)

__ Repeat Vendor requesting same space as 2008 (reply by June 1)                ____spaces @ $35 =   __________ amt. due

__ Repeat Vendor requesting different area than 2008 (reply by June 1)         ____spaces @ $35 =   __________ amt. due

__ Repeat Vendor after June 1; will accept space available                             ____spaces @ $35 =   __________ amt. due

__ New Vendor – first received, first assigned (reply by June 30)                   ____spaces @ $35 =   __________ amt. due

__ New Vendor – late registration(after July 1) – assigned until full                 ____spaces @ $45 =   __________ amt. due

Show personnel reserve the right to screen vendors’ merchandise to maintain variety and to adjust space assignments as necessary for traffic patterns or park modifications.

Make checks payable to: Momence Chapter AACA

Mail to: Jeanne Marcotte; 1752 N12000 E Rd.; Momence, IL 60954 (815-472-3403)

I hereby declare that I release, indemnify, defend, and hold harmless the Momence Chapter AACA, its officers, its members, and its directors from any liability, damage, injury, losses, or claims, personal or otherwise, that might be incurred or arise out of or in connection with this show.  I affirm that my vehicle(s) and/or my possessions are fully covered by all necessary property damage insurance.  I agree not to display or sell firearms, pornography, or items illegal under Illinois statutes.  I also agree to abide by the regulations of the show as set forth in this brochure.