2. Business Name
3. Tax ID#
5. Name*
6. Email*

   Please note: emails from the City of Derby are sometimes filtered to junk mail or unable to send to Gmail addresses.

8. Address*
9. City*
10. State*
12. Zip Code*
13. Cell Phone
14. Home/Business Phone*
15. Power Needed*

    1. Yes
    2. No
17. How did you learn about this event?*
19. Detailed description of handcrafted/original artworks*
21. Booth/Art Photo*
22. Booth/Art Photo*
23. Booth/Art Photo*
25. Optional: please provide URLs to your website or social media page(s) to be used for marketing purposes.
27. Additional Information/Special Requests
29. Booth Fees

    Booth fee is $25. We will send a link to payment options, PayPal or upon approval or you can mail a check to the address below. Please note, event will follow COVID guidelines. If we are unable to hold the event due to COVID restrictions or inclement weather, booth fees will be refunded. Booth fee will not be refunded for any other reason. In case of inclement weather the event will move indoors to the The Venue.

31. Pay by Check

    Make checks payable to: City of Derby 

    Mail to: 
    City of Derby Attn: Janae Springer 
    611 Mulberry Rd. Suite 300 
    Derby, KS 67037

33. Release
    In consideration of my participation in this activity, I hereby release and discharge the City of Derby and all persons connected with this activity from any and all issues arising from illness, injuries and damages I may suffer as a result of my participation in this activity. I also understand that the City of Derby is not responsible for any cost incurred for medical services while participating in this activity, or loss of merchandise while exhibiting. I acknowledge that I have read and understand the rules and regulations concerning this activity.
35. Release Consent

    1. Yes
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field