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2. Contact Information
4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Email Address
16. Business Name
17. Social Media Handle (Facebook)
21. Vendor Details
23. What type of products do you sell?*
25. Do you have a BBQ pit, generator, or grill? *

    1. Yes
    2. No
27. Do you plan on attending every week?*

    1. Yes
    2. No
29. If not, please list the weeks and dates you will attend*
33. Electronic Signature Agreement

    I agree to Hold Harmless: Gavin Hereford, Christine Toca, the City of Kenner, its districts, Departments and Agencies, The Market at Kenner City Park, and Farmer's Market Hub, LLC from any damages, loss, costs, attorney fees, injury, death or any other reason that may arise. I have read and understand the above information. I agree to the terms and conditions of this application. 

    1. I agree.
35. Electronic Signature
36. Date
    Date
Leave This Blank:


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

    This field is not part of the form submission.

40. Submit

* indicates a required field