Agency/Organization* |
|
Address* |
|
City* |
|
Zip |
|
State |
|
Country |
|
Contact Person* |
|
Phone* |
|
Email* |
|
Description of Exhibit (please give a detail description of how your booth will be used. i.e. sales, display, recruitment, food, etc. |
|
|
|
|
|
|
|
|
If You Wish to Register for a Booth by Paper Form
Please Click HERE to Download the Form and:
SEND COMPLETED REGISTRATION AND PAYMENT TO: |
JUNETEENTH-JEFFERSON CITY
P. O. Box 1241
Jefferson City, MO 65102-1241
State Vendor Number: 2624949250-0 |
For information or questions please contact: W. T. Edmonson |
(573) 893-4191/ Fax: (573) 893-5562 or e-mail: juneteenthjc@aol.com. |
|
Signature |
|
Date |
|
| |