Jack's Mountain Blues Festival 2015 Vendor Registration Form
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Name of Business/Organization *
Contact Person *
Phone Number *
Street *
City *
State *
Zip Code *
Cell Phone Number
E-mail Address *
Type of Vendor *
FOOD VENDORS ONLY: Specify Items for Sale
FOOD VENDORS must have a copy of your SERVSAFE certification.
FOOD VENDORS ONLY: Item Pricing Range
Vendor Fees
One 10’ x 12’ Space Friday & Saturday – Purchase of Festival ticket @ $25 for each attending vendor and associate. You will need to add up your total and send your payment to jacksmountainbluesfestival1@gmail.com by going to: https://www.paypal.com/webapps/mpp/send-money-online

You can also send payment in the mail by check (by 6/15) or by paying at the gate.
Send checks to:
Jack's Mountain Blues Festival
PO Box 255
Mifflinburg, PA 17844
Payment Sent Through *
Number Of Attending Personnel @ $25 Each *
Number Of Days Attending Festival (check all that apply) *
How many Spaces Do You Need? (10’x12’) (include tent stakes, awning, hitches,) *
Do you have a *
Do you require electricity? *
$35 Hook-up Fee.
Do you have a generator? *
How many 110 plugs?
How many 220 plugs?
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