Juneteenth Block Party Vendor Registration Form

Juneteenth Block Party Vendor Registration Form
Your Name*

First NameLast Name
Business Name or Organization*
E-mail*
example@example.com
Phone Number*

Area CodePhone Number
Description of Business or Organization*
Black Chamber members are covered by insurance, if you are not a member, you are required to have insurance coverage? Are you covered by insurance?*

YesNo
Type of Business*

BusinessFood TruckNon ProfitInformational
Vendor and informational spaces are 10x10'. All food trucks will be located in the church parking lot on Jackson street. Trucks are not authorized on the street.
Please check appropriate box and remit payment. You will be redirected to payment link when you hit the submit button. Your submission will only be generated and secured when payment is received.*

Black Chamber Member ($25.00)Non Member ($30.00)
Should be Empty: