Contact Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Sponsorship Level *

Ruby Prince $4,500

Southern Pearl $2,500

June Gold $1,000

Harvester $500

White River $300

Will you need a vendor space? *

Yes

No

Payment options *

I will pay by phone to 205-755-2400.

I will mail my payment to P.O. Box 2126, Clanton, AL 35046

Agreement *

I have read the terms and conditions set forth in the application and guidelines. I agree to abide by them and such other rules and regulations as established by The Chilton County Chamber of Commerce. The undersigned does hereby and forever discharge the Peach Jam Jubilee, Chilton County Chamber of Commerce, City of Clanton, its agents, representatives, and employees of and from all manner of action, suits, damages, claims and demands whatsoever in law and equity from any loss or damage while in the possession or auspices of the event, namely the Peach Jam Jubilee.

I agree

I do not agree