BIZZY BEE-A PROVIDENT LIVING RETREAT

INFORMATION AND ENTRY FORM

WILLOW GLEN INN-3380 N. Bulldog Road, Enoch, UT 84721

SATURDAY SEPTEMBER 17, 2011 9AM-7PM

SET-UP TIME BEGINS ONE HOUR PRIOR TO OPENING.

The event, free to the public ,will include entertainment, provident living workshops, free educational demonstrations .

ALL BOOTHS: There is a $25-DISCOUNTED  fee for 2011, to be paid to Nature Hills Farm, for each space required, up to 10' x 10'. Power is available. However: No canopies, chairs, tables or other items will be provided by the sponsors.

✓BOOTHS FOR FOOD VENDORS: If you are an established restaurant in Cedar City, your food handler’s permit will be honored for this event. ✓If you are licensed with the Utah Health Department at another location, or have a seasonal or temporary permit, proof of said permit must be provided. ✓If you are a non-profit group or temporary food establishment, you must meet the requirements as set out by the Southwest Utah Health Department. You may phone 586-2437 for copies of the requirements or for the Temporary Food Service application. All Health Department requirements must be met prior to setting up your booth at the event. Those who fail to do so will forfeit their fee.

Please return the lower portion of this form with your $25  fee so that we may assign your space. You will be telephoned or e-mailed with that information no later than noon, Wednesday, Sept. 14. An information booth will be located beginning at set-up time at the main entrance to the park (200 North Main) to assist you if necessary.

Otherwise, you may set up in your assigned space (designated by a flag with a number). Following your set up on site, you will be provided with tax forms from the Utah State Tax Commission.

Name (individual and business)____________________________________________________________________________

Address_______________________________________________________________________________________________

Phone number _________________________________E-mail address____________________________________________

Type of business _______________________________________________________________________________________

Description of booth (list any food items or sound, music, etc.): ____________________________________________________

WAIVER OF LIABILITY

By signing this form, I agree to indemnify, defend and hold harmless Nature Hills Farm, Alive Utah! and Willow Glen Inn and its officers and agents,  and the State of Utah and their agents and members, employees, elected and appointed officials, from and against all claims, damages, losses and expenses arising out of or resulting of Bizzy Bee Retreat September 2011 except

claims resulting solely from the negligence or willful acts or omissions of the above mentioned. I also agree to indemnify and hold the sponsoring parties harmless from all claims and injuries to any and all persons, and for loss of and damage to property resulting from or by reason of my utilization thereof.

Signed _________________________________________________________________________________

PLEASE COMPLETE AND DETACH THIS LOWER FORM AND MAIL WITH PAYMENT TO:

Nature Hills Farm/ Alive! Utah, PO Box , Cedar City, UT 84721-

For more information, phone Heather Harris (435)559-4380, Rachelle Hughes (435)531-9125  

Or register online at www.bizzybeeretreat.com