Name *

First Name

Last Name

Phone Number *

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Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you need Electricity? *

Yes

No

Do you need Internet/Wifi? *

Yes

No

By submitting this form you acknowledge that you have read the below waiver: *

The undersigned waives all right, and without limit upon or liability for the use of their property and facilities and holds harmless the Trempealeau County Agricultural Society, Inc. The undersigned agrees the Trempealeau County Agricultural Society, Inc. may use photos for publicizing the event. I have read these rules and agree to the terms of this contract.

Yes

No