Medfield Day 2010
Exhibitor Booth Registration Form
Date: Saturday, September 25, 2010
Time: 9:00 am - 3:00 pm
Severe Weather Date: Saturday, October 2, 2010

Corporate Sponsorships
For Sponsorship information, please contact Mary Roque at 617-584-4314 or  roqueelderlaw@gmail.com
For Sponsor Benefits information Click [Here]

Registration Instructions
  1. Read Medfield Day Exhibitor's Letter [Click Here to Read]
  2. Read Medfield Day Exhibitors' Information. [Click Here to Read]
  3. Read Special Notice for Food and Beverages. [Click Here to Read]
  4. View Medfield Day Booth Placement Map [Click Here to View]
  5. Complete and Submit this Registration Form Below.
  6. MEMO will process your registration and reserve your booth number, if available, while waiting to received your payment.
  7. After you submit the Form, you will receive a Registration E-mail Confirmation containing the information you submitted.  (Make sure you enter a valid e-mail address that you have access to.)
  8. When you receive the Registration E-mail Confirmation print a copy and mail it, along with correct payment, to:
    Cheryl O'Donnell at Rockland Trust, 76 North Street, Medfield, MA 02052
    OR
    MEMO, P.O. Box 6, Medfield, MA 02052
  9. MEMO will contact you via E-mail or Phone to confirm payment and/or Booth number and placement.

Business and Contact Information
Business or Organization Name:
Mailing Address: Street or P.O. Box


City: State:   Zip:
Contact Person:
Telephone No.:
Fax No.:
Contact E-Mail:

Previous 2009 Exhibitor?:

Booth Selection
Choose Booth Type:
Medfield
Businesses/Organizations
Medfield Residents,
Medfield Businesses or
Medfield Organizations		 Non-Medfield
Businesses/Organizations
Non-Electric $150
Electric $200
Food Court:
Restaurants and
Community
Organizations		 $125         N/A
Preferred Booth No.:   Booths are distributed with preference given to prior year's Exhibitors through June 15, 2010, and for MEMO Members and remaining prior year's Exhibitors through June 30, 2010.  July 1, 2010 registration opens to all.
Please provide a detailed account of your proposed Booth's activity. Include SPECIFIC food and beverage activity if applicable:

Food and Beverages Information
Will Food and/or Beverages be Sold or Handled in your Booth? (If Yes, complete this section before continuing to next section.)
Food and Beverage Contact: Name:

Phone:   Fax:

E-mail:
On-Site Food and Beverage Contact: Name:

Phone:   Fax:

E-mail:
MEMO Medfield Day Blanket Permit:

Request for inclusion under the Medfield Day Blanket Permit for One Day Victualer’s License.


If No, provide a copy of your Victualer's Permit and your ServeSafe Certificate by one of the below methods:

E-mail:
Fax:
Mail:
Hand:		 Russ Hallisey    russ.hallisey@verizon.net
Russ Hallisey    508-359-7877
MEMO, PO Box 6, Medfield, MA  02052
Cheryl O’Donnell, Rockland Trust, 76 North Street, Medfield, MA  02052

Food Preparation and Serving:

(Please provide a complete description.)

 Category 1 restaurants & others cooked off-site
- Where is food prepared?
- How dealing with ServeSafe
- Refrigeration plan (coolers, ice, thermometors, etc.)		 Describe:
Category 2 hot dogs, sausages, hamburgers, etc cooked on-site
- Refrigeration plan (coolers, ice, thermometors, etc)
- Serving plan (tongs, gloves, etc) 		Describe:
Category 3 baked goods, other
- What is being served (perishable?)
- Where is food prepared?
- Refrigeration plan (coolers, ice, thermometors, etc)
- Serving plan (tongs, gloves, wrapped, etc) 		Describe:
Special Notice for Food and Beverages
[Click Here to Read]		 By Checking below, the Exhibitor acknowledges that s/he has read, understands and agrees to the information contained in the Special Notice for Food and Beverages.


Exhibitor Authorization and Acknowledgement
Medfield Day Exhibitors' Information
[Click Here to Read]

Each Exhibitor and all persons associated with that Exhibitor and/or that Exhibitor’s Booth must comply with MEMO’s Medfield Day Exhibitors' Information. Failure to comply with the above may result in termination of your participation in Medfield Day. (Currently or in the future.)

By Checking below, I state that I have read, understand and agree to the MEMO's Medfield Day Exhibitors' Information.

Read, Understand and Agree

Exhibitor Authorization and Indemnification

The Medfield Employers and Merchants Organization, Inc. (MEMO) assumes no liability of any kind for personal injury to the Exhibitor and/or persons/entities associated with the Exhibitor or persons injured by the Exhibitor’s conduct of any kind.

MEMO assumes no liability of any kind for damage to property or loss resulting from damage to property, including any property of the Exhibitor, any persons associated with the Exhibitor, or any persons whose property is damaged by the Exhibitor. Property is deemed to include intangible and intellectual property.

By Checking below, the Exhibitor acknowledges that s/he has the authority to bind all persons or entities affiliated with the Exhibitor and that all such agree to hold MEMO harmless from and to indemnify MEMO for any and all liability occasioned by the operation of any booth by said Booth Exhibitor or his or her agents.
Submit Registration


 

Click Submit button Once only, to prevent multiple submissions.