Name of Non- Profit Organization____________________________________________________

Tax exempt #________________________________________________________

Name of contact person ____________________________________________________________

Phone_____________________________________ e-mail________________________________

Address_________________________________ City_________________________________

State___________ Zip_________________________

Please give a brief description of information you will distribute or sell at the festival:

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

READ AND SIGN THE FOLLOWING DISCLAIMER :
I, the undersigned, agree to the terms and conditions of participating in the Blissfest Festival and release and hold harmless the Blissfest Music Organization and its employees from all claims, or action, which may hereafter occur by reason of any damage, loss, or injury which may be sustained by the undersigned in consequences of being allowed to participate in the Blissfest on JULY 11-13, 2008

Signature____________________________________________________________________

Date________________________________________________________________________