Brandon Hobza

Period 7

Cumberland Mountain
Fall Festival
October 7- October 10, 2014
Middlesboro, Kentucky
Application Form
1300 Church Ave.,
Middlesboro, KY 40965

____________Antique
____________Business
____________Craft
____________Demonstrator
____________Food

Applicant Name _________________________________________________________

Organization Name ______________________________________________________
Address ________________________________________________________________
City __________________________State _____________Zip ____________________
Day Phone __________________________Evening Phone ______________________
Email Address __________________________________________________________
Type of items to be sold __________________________________________________
Special Note ____________________________________________________________
By submitting this application to the Cumberland Mountain Fall Festival Committee,
the undersigned acknowledges receiving, reading and fully understanding all of the
guidelines and regulations of The Fall Festival Committee. I do herby waive and
releases any and all claims against the sponsors, The City of Middleboro and/or
Southeast Kentucky Community & Technical College, form any and all damages, loss or
cost to person or property resulting either directly or indirectly from the use of said
premises. No refunds after September, 1, 2017.

Signed _________________________________________________________________
Date ___________________________________________________________________
Brandon Hobza
Period 7