Emergency!! Sponsorship

Primary Contact *

First Name Last Name

Phone Number *

Please enter a valid phone number.

Email *

example@example.com

Department or Agency *

Year *

Manufacturer *

Type *

Participating in Parade? *

Yes No

Static Display? *

Yes No

Entry *

Insurance Carrier *

Policy Number *

Effective Date *

Date

Expiration Date Date *

Date

The apparatus or vehicle I am entering will be in sound mechanical condition, roadworthy as required by the state in which the apparatus or vehicle is registered and will carry public liability and property damage insurance, as indicated by the policy number above, for the day of the muster and for any time the apparatus or vehicle will on muster grounds. I agree to hold The City of New Haven, New Haven Fire Muster Inc., The New Haven Fire Department, The New Haven Volunteer Fire Department, The Fort Wayne Firefighters Museum, and Hoosier Bum Camp harmless for any liability I/we incur, Each piece of apparatus will have a working 5 lbs. ABC fire extinguisher present on the apparatus/vehicle and appropriate wheel chocks. I acknowledge that I have read and will follow these basic safety rules and regulations.

Name *

First Name Last Name

Signature *

Clear

Date *

Date

Payment Options

Please mail your check to

Emergency-Event

910 Hartzell Rd.

New Haven, IN 46774

Attn: Jon Stauffer

Please make checks payable to: Playing With Fire Inc.

Pay By Credit Card

Commercial Registration

$ 50.00

I am a Registered Vendor

Free

Total

$ 0.00

Payment Methods

Credit Card

Apple Pay

Google Pay