International Festival Display a Culture Form

What culture would you like to represent?*

Main Contact Full Name*

First NameLast Name

Phone Number*

E-mail*

example@example.com

Please select the option that best reflects who is hosting this table*

OrganizationIndividualBusiness

Name of Organization

Name of Business

How will you display your culture? (Example: Items, artifacts, activities)*

(Example: Items, artifacts, activities)

List the first and last name(s) of all table host participants*

Provide any additional information you would like to share with Wheeling Park District

To the extent permitted by law, any participant(s) shall indemnify, save, defend and hold harmless the Park District, including its officers, officials, agents, volunteers and employees (collectively “Park District”) from and against any and all liabilities, obligations, claims, damages, penalties, wage and hour claims, cause of actions, costs and expenses (including reasonable attorney and paralegal fees) which the Park District may become obligated by reason of any accident, bodily injury, or death of persons, civil or constitutional rights violation, or loss or damage to tangible property, or any claim made under the Fair Labor Standards Act or any other federal or state law arising out of any negligent or wrongful act of Community Organization (or anyone acting on behalf of Community Organization) and directly or indirectly in connection with, or under, or as a result of this Agreement.

By Signing this form, I agree to the stated terms, guidelines, and waiver indemnification.

Signature*