APPLICATION -FILL IT OUT COMPLETELY. BE SURE TO SIGN IT

NAME ________________________________________________________________________________
TEL _________________________________________ E-MAIL __________________________________
ADDRESS _____________________________________________________________________________
CITY ____________________________________ ST ________________________ ZIP _______________
TYPE OF ART/CRAFT ___________________________________________________________________
SHOW DATE ________________________ SHOW NAME/LOCATION ____________________________
AMOUNT ENCLOSED $_____________
The Broken Mold and any other entity affiliated with the above named event shall not be held liable for damage, inclement weather, theft, injury
and/or vandalism. Exhibitor also agrees to abide to all Exhibitor Guidelines.

Exhibitor's Signature________________________________________________ Date _________________

APPLICATION -FILL IT OUT COMPLETELY. BE SURE TO SIGN IT

NAME ________________________________________________________________________________
TEL _________________________________________ E-MAIL __________________________________
ADDRESS _____________________________________________________________________________
CITY ____________________________________ ST ________________________ ZIP _______________
TYPE OF ART/CRAFT ___________________________________________________________________
SHOW DATE ________________________ SHOW NAME/LOCATION ____________________________
AMOUNT ENCLOSED $_____________
The Broken Mold and any other entity affiliated with the above named event shall not be held liable for damage, inclement weather, theft, injury
and/or vandalism. Exhibitor also agrees to abide to all Exhibitor Guidelines.

Exhibitor's Signature________________________________________________ Date _________________

APPLICATION -FILL IT OUT COMPLETELY. BE SURE TO SIGN IT

NAME ________________________________________________________________________________
TEL _________________________________________ E-MAIL __________________________________
ADDRESS _____________________________________________________________________________
CITY ____________________________________ ST ________________________ ZIP _______________
TYPE OF ART/CRAFT ___________________________________________________________________
SHOW DATE ________________________ SHOW NAME/LOCATION ____________________________
AMOUNT ENCLOSED $_____________
The Broken Mold and any other entity affiliated with the above named event shall not be held liable for damage, inclement weather, theft, injury
and/or vandalism. Exhibitor also agrees to abide to all Exhibitor Guidelines.

Exhibitor's Signature________________________________________________ Date _________________