2013 Qualicum Beach Family Day

Please provide the following information if you are interested in providing street entertainment along Second Avenue from 11:30 to the parade start.

Indemnity Agreement *	Yes. I have read, understand and agree with the Indemnity Agreement.
Group Name *
Contact Person *
E-mail *
Phone
Cell
Mailing Address
Mailing Address 2
Postal Code
How would you describe the type of entertainment you will be providing?
Number of participants
Comments
Enter Code *

Thank-you very much for your interest in supporting this year's Family Day, should you have any questions please do not hesitate to contact the planning committee. Phone: 250-738-2198 Email: info@qbfamilyday.com