Sunday, 7 May 2017
Glen Willow Regional Sports Stadium, Pitts Lane Mudgee

PLEASE RETURN COMPLETED FORM BY MARCH 15, 2017:
Joanna Lindsay
Events Officer, Mid-Western Regional Council
P: 02 6378 2850
E: joanna.lindsay@midwestern.nsw.gov.au

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* 1. Business Name

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* 2. ABN (if applicable)

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* 3. Contact Name

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* 4. Postal Address

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* 5. Suburb

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* 6. State and Postcode

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* 7. Phone Number

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* 8. Mobile

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* 9. Email Address

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* 10. Website

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* 11. Products to be sold

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* 12. Do you require access to power? (please note access to power is limited and can't be guaranteed

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* 13. Do you have Public Liability Insurance? (please contact us if you do not hold current Public Liability Insurance)

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* 14. Do you hold a current Food Safety Supervisor Certificate? (please not you will need to provide a copy of this)

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