PLEASE NOTE:  2011 Fees -  $110.00 plus HST

Business/Name _________________________________________________________________

Address_______________________________________________________________

City __________________________________________________________________

Postal Code ___________________________________________________________

Tel (Home)____________________ (Bus.)____________________

Email____________________________________________________________________
This is important as notifications will arrive by e-mail.

Website address___________________________________________________
(This will help visitors to the site link to your own personal website if you have one)

Description of products  ________________________________________________________

Fees:  ($110.00  plus HST 12%) = $123.20

My total fees (cheque payable to "The Town of Comox") are submitted with this application.
  
Date____________________________________________________  

Signed__________________________________________________   

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This waiver must be submitted along with your application:

Originals Only Art Show and Sale Liability Waiver

-November 5th & 6th 2011 - Comox Recreation Centre

With my acceptance as a participant in The Originals Only Art Show and Sale or any activity associated with it, I agree to release The Town of Comox and the Organizing Committee of the Originals Only Shows and/or their employees, agents or volunteers from and against all claims, actions, costs, expenses and demands in respect of death, loss, injury or damage to my person or property whatsoever caused, arising out of or in connection with my taking part in the event and notwithstanding that the same may have been contributed to or occasioned by any act or failure to act ( including without limitation, negligence ) of members of The Originals Only Group, The Comox Recreation Commission, The Town of Comox and/or any one or more of their employees, agents or volunteers. This agreement is binding on me, my heirs, executors and administrators.

I have read and understood the above waiver.

Name __________________________________________

Signature _______________________________________

Date ___________________________________________

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Please contact Liz regarding Advertising Opportunities in
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