CAI Registration Form Organization/Agency Contact Person/Title Address Phone Number Email Address Type of Registration Community Agency Artist Volunteer Other How would you like to be involved? Host a resource table Teach art and crafts workshop Show art work Performance Other Are you able to help us by donating any of the following to the event? Donate an item to the silent auction (piece of artwork or service) $25 (toward food expenses) Questions or comments? Cultural Art Imbizo Participation Statement (please read carefully and sign) I agree to be a participant in the Cultural Art Imbizo on Friday, August 26th,2011 and agree to being there at least 30 minutes early to set up my materials. If for any reason, my group cannot come to the event, I will call immediately to inform WISE. I understand that WISE will provide me with one (1) table and two (2)chairs at the event. As a participant, I assume full responsiblity for all my equipment and products, and hold WISE harmless. I take full responsiblity for obtaining insurance coverage for any damage, theft, and /or loss that might occur at the event. Furthermore, I give WISE permission to you any video and/or photgraphy of my organization/representatives for public relation purposes. I have carefully read and agree to abide by the above statement: Electronic Signature (type in your first and last name) *