All Decked Out - a fashion boutique experience Please complete the form below to participate in All Decked Out benefiting The Children's Center of Medina County. You can either submit payment through PayPal, Credit Card or mail to Jeanne Hurt, Bloom Event Planning & Management Services, 303 N. Court Street, PO Box 106, Medina, OH 44258. Company (required) First Name (required) Last Name (required) Email Address (required) Confirm Email Address (required) City (required) State ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Zip Code (required) Phone Please List the items you will be selling: There will be one Grand Boutique Raffle Basket, are you willing to donate an item for the basket? YesNo If so, please indicate the item you will be donating. Exhibitor Agreement By submitting this registration you agree to indemnify and hold harmless Bloom Event Planning & Management Services LLC and the Medina County Women’s Endowment Fund, any benefactors, sponsors, officers, agents and employees against all claims, losses, suits, damages, judgements, expenses, costs and charges of every kind resulting from its occupancy of the space herein contracted for by reason of personal injuries, death, property damages or any other cause sustained by an persons, loss or damage to displays or goods belonging to you whether resulting from fire, storms, acts of God, theft, pilferage or other causes. I agreeI disagree Fee 10 x 10 Space: $10020 x 20 Space: $200 Additional Items 8" Table - Max Limit: 4 Qty: 0 Tables - $0.001 Table - $10.002 Tables - $20.003 Tables - $30.004 Tables - $40.00 2 Chairs Qty: 0 Chairs -$0.001 Chair - 5$2 Chairs - 10$3 Chairs - 15$4 Chairs - $205 Chairs - $256 Chairs - $307 Chairs - $358 Chairs - $409 Chairs - $4510 Chairs - $50 Payment Method: Paypal or Credit/Debit CardCheck Please mail payments to: Jeanne Hurt, Bloom Event Planning & Management Services 303 N. Court Street, PO Box 106 Medina, OH 44258.