2019 Summer Programs Fair - Long Table Vendor Registration 1234 Name of the Organization* Name of person who will be the contact for this event* First Last Address* Phone number of person who will be the contact for this event*Email address for person who will be the contact for this event* Enter Email Confirm Email Website (if available) I would like to reserve a rectangular display table* Long Table ($90) Do you need an electric outlet for your table?* Yes No Description of Your Program (check all that apply)* Art Academics (Math, Writing, SAT, PSAT, etc) Business and Entrepreneuship Communications Competitions Leadership Music Sports Science and Technology Speech and Debate Teen Programs Travel General Targeted Age Group (choose best fit)* Grade PreK - K Grades K-3 Grades 4-6 Grades 7-8 Grades 9-12 All Location of the Program (City, State)*If more than one, list the one closest to Fremont, CA Number of Attendants at Your Table (you can provide an estimate for now and update us later)* Number of Attendants at Your Table who prefer a vegetarian dinner (you can provide an estimate for now and update us later)* Will you also provide internship opportunity? If you are not sure, you can select "Yes" or "No" for now, and update us later. Yes No Description of your program for our handoutWe are giving a handout to everyone that attends the Fair. This handout lists all the vendors at the Fair. Each vendor will have one line in the handout. Please provide a short description of your organization and/or the programs and services you provide. You have a maximum of 90 characters, including the name of your organization. If you have participated in our Fair before, and you want to use the same description, just enter "same as last year". Liability Waiver* I agree to all the terms and conditions of FUSS Liability Waiver ASSUMPTION OF RISKS I understand the program offered through Fremont Unified Student Store (FUSS) may include, but is not limited to, the following potentially hazardous indoor and outdoor activities: sports, initiative activities, games and events. The inherent risks of these activities may cause, but is not limited, to the following: personal injury, property damage, property loss, illness or death. I understand that my participation in the program is voluntary. RELEASE OF LIABILITIES In recognition of the nature of the program, I, or my child, my heirs and assigns, hereby release FUSS, its directors, officers, professional staff, employees, volunteers, agents, promoters, other participants, operators, officials, person(s) in any event area, sponsors, advertisers, owners and lessees of the premises used to conduct the event, from any and all claims of negligence arising from participation in the program. I further agree to hold harmless and indemnify FUSS, its directors, officers, professional staff, employees, volunteers, agents, promoters, other participants, operators, officials, person(s) in any event area, sponsors, advertisers, owners and lessees of the premises used to conduct the event for all defense costs, including attorney fees, and any other costs, expenses or claims in connection with my participation in this program. I also understand that this release relates to all claims and liability resulting from unforeseen circumstances. CONSENT FOR USE OF NAMES, IMAGES, PHOTOGRAPHY AND RECORDING I hereby give FUSS my consent to use my name, quotes, photos/images, and to take photographs, video recordings, and/or sound recordings of me during my participation. I grant FUSS my permission to use the negatives, prints, motion pictures, video tapings, or any other reproduction of the same for promotional purposes on flyers, on the World Wide Web, or in any other manner deemed necessary to raise fund to support Fremont Unified School District students, schools and programs. PERMISSION FOR MEDICAL CARE In the event of illness or injury, I hereby consent to any and all of x-ray examination, anesthetic, medical, surgical, or dental diagnosis of treatment and hospital care that are deemed necessary by the attending physician, surgeon, or dentist and performed by or under the supervision of a member of the medical staff of the hospital or facility furnishing medical or dental services, and I agree to pay for such medical or dental care whether or not such care is covered under, or the costs are insured by, my health insurance. FUSS representatives are authorized to call 911 in case of an emergency. Exhibitor (Authorized Signer)* First Last Date* MM slash DD slash YYYY THANK YOUThank you for your interest in participating in the FUSS 2019 Summer Programs Fair. Total Due $0.00 Payment Method* Online Payment using Paypal or Credit Card Check sent via US Mail Online payment instructions: We use PayPal to process credit card payments, but you do not need a PayPal account to use their payment system. After clicking "Submit", you will be taken to the PayPal website. At the bottom of the screen, click on "Pay with Debit or Credit Card". You will be asked for your credit card. You will receive a receipt via email from PayPal. You will also get a confirmation email from us. The following information will also be sent as a confirmation email: Please have checks postmarked by Friday, February 22, 2019 , and make checks payable to Fremont Unified Student Store. Please mail to Fremont Unified Student Store 47000 Warm Springs Blvd., Ste. 266 Fremont, CA 94539EmailThis field is for validation purposes and should be left unchanged.
