Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Do you absolutely require your vehicle at your market stall?** *

Yes

No

Do you require one vendor stall (12ft x 12ft) or two? *

One

Two

Do you make ALL OF YOUR PRODUCTS YOURSELF? *

Yes

No

DO YOU HAVE ANY SPECIAL REQUIREMENTS? *

Yes

No

Do you plan on being at every Saturday Market? *

Yes

No

Have you been approved by Public Health to sell at the market? *

Please send your approved form from Five Hills Public Health Region to mjhomegrownmarket@gmail.com

Yes

No

STAY In Touch!

In order to receive important information regarding time changes, cancellations and other info we need to be able to get a hold of you! How can we reach you?

Cell ( TEXT)

Email

Phone call ( we will attempt to call and leave a message, if you do not have a voice mail account, please consider a different method of contact)

Date of Application *

MM

DD

YYYY