Please reserve _________ space(s) in Building #6 for:

Company/Organization Name: _____________________________________________________

Contact Person: ________________________________________________________________

Mailing Address: _______________________________________________________________

                 _______________________________________________________________

Telephone: ___________________________

Cell Phone: __________________________

E-Mail Address: ________________________________________________________________

PA State Tax ID Number: ____________________________Required

          Number of 10x12 ft. Spaces _______ X $125.00 = $_________________

          Number of tables ______ X $5.00 Per Table      $_________________

                 Total Due by July 15:                   $_________________

Return form to:
            Jim Conklin
            249 Dug Hill Road
            Biglerville, PA 17307

Please make checks payable to: South Mountain Community Fair Association

Questions:  Please contact Jim Conklin at 717-677-4766 or email
            to jconklin@labsinceb.com.

Receipt will be acknowledged.