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Registration Form

Registration Form

2nd Annual Coal Miners Heritage Festival

Sunday July 12, 2009

10 AM to 5 PM

No. 9 Coal Mine and Museum
Lansford, PA

Name of Applicant:_________________________________________________

Business/Organization Name:________________________________________

Address:___________________________________________________________

Town / City:______________________State:___________Zip Code:__________

Home Phone:______________________Business Phone:___________________

Cell Phone:____________________Email address:________________________

Type of Goods you will be displaying or selling? (this form not for food vendors):
______________________________________________________________

Space sizes: 10 X 10 (all spaces are outdoors)

Cost per space: $20.00 No. of spaces you are interested in?__________

Electricity is not provided Please bring your own tables, chairs and canopy

This is a rain or shine event no refunds once you register

Mail Completed Registration Form To:

Dale Freudenberger, 110 N. 3rd Street, Suite 220, Lehighton, PA 18235.

For more Information Phone Dale at 610-377-4063

or email to dale@delawareandlehigh.org