Name:       Phone No:  

Address:	Mississippi State Tax Number:  Note:  A Complete Exhibitors List will be furnished to the Mississippi State Tax Commission.
Internet Email Address (if any):	Your Website Address (if any):

For further information or questions, please call us at 601-765-6012.

Please indicate below, the number of booths desired. 
Booth Space and booth locations will be assigned.

Arts and Crafts (10' x 10')	Food and Drink (12' x 12')
I need  booth spaces with no electricity at $45 per booth.	I need  booth spaces with no electricity at $100 per booth.
I need  booth spaces with electricity (20 amps) at $55 per booth.	I need  booth spaces with electricity (20amps) at $110 per booth.

Product Description:  

Products NOT Allowed:  Knives, silly string, and snap pops.

Registration Fee must be received by April 25, or a $5.00 late fee will be assessed.

Please Make checks payable to:   Covington County Chamber of Commerce

Total Enclosed $

You may print this application and mail or fax to:

Covington County Chamber of Commerce, PO box 1595, Collins, MS 39428. 

Fax:  601-765-1740