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Worcester, VT Historical Society
P.O. Box 329 ~ Worcester, VT 05682
Buy Local Donation/Application
Saturday, May 17th, 2008 ~ 10am -1pm
Doty Gym Worcester, VT

Please Print form, complete and return to:
Suzanne Mancinelli
114 West Hill
Worcester, VT 05682

Name_____________________________________________________________________________
Company Name_____________________________________________________________________________
Address___________________________________________________________________________
City____________________________________________State________Zip___________________
Phone______________________________________  Cell___________________________________________
Email (for use only if there is a problem with the order)_________________________________ok to print?
Website:__________________________________________________________Yes__ No ___
Description of Donation for Silent Auction or Activity Donation
– please bring donations or set -up activities at Doty by 9am
   prior day drop-off can be arranged - please call 223-1505
– Silent Auction Donations are best valued at $25 or better.
– If your activity is food as a fund raiser for your group please donate 10 % of your sales to the fireworks
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Retail Value ________________________
Booth Space Specifications:
The room will be marked off in approx. 10’x10’ booth spaces around the walls of the room.
Please bring your own set-up if you can!
Do you need a table? Yes___ No ____ 4ft___ 6ft___ 8 ft___ (first requested first served, table availability is limited)
Will you have someone at your table? Yes _____ No_____
Will you need to be near an electrical outlet? Yes _____ No_____
Will you be selling products at your table? Yes _____ No_____
If Yes, what will you be selling?_____________________________________________________________________
Contact: Suzanne@dryaddesign.com  or call Suzanne 223-1505 with any questions.
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