Participant Registration Form

Participant Registration Form 2024

Space is limited. Please complete, sign, and return registration form no later than December 30, 2023. Include Certificate of Liability Insurance listing Miami Lakes Town Foundation as an additional insured.

Business Name(Required)

Business Information(Required)

*Event organizers reserves the right to assist with selection of showcased item(s) to avoid duplication of same or similar items or products in an effort to maximize the options available to the attendees. Event organizers reserve the right to limit or refuse a participant.

CONTACT INFORMATION

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

SOCIAL MEDIA INFORMATION

Facebook

Instagram

Twitter

YouTube

DESCRIPTION OF FOOD, WINE, OR BEER

Please provide a brief description of the food, wine, or beer planned to be provided.(Required)

HOLD HARMLESS

For myself or individuals attending with me, as a vendor or a sponsor, using a facility and attending an event of the Miami Lakes Town Foundation a 501©3, I hereby waive any claim against the Miami Lakes Town Foundation and it’s agents, servants and employees hereafter arising from injuries sustained while participating in or using said facilities to myself or said individuals. I do covenant to indemnify, hold harmless and defend the Miami Lakes Town Foundation, its agents, servants and employees from any claim, damages on demand hereafter arising out of any injury to myself or said individuals regardless of whether such injury to said individual or to myself is caused in whole or in part by the negligence of Miami Lakes Town Foundation or by the negligence of the agents, servants and employees of the Miami Lakes Town Foundation.

Signature(Required)

Date