Registration Form

Complete and Mail to:
Chesterfield Days
P.O. Box 95 Chesterfield, IN 46017

We would like to invite you and your group to join us for this event.  The undersigned entry, its employees, agents, and volunteers, hereby agree to release indemnify, and hold harmless the Chesterfield Festival Committee(CFC), Town of Chesterfield, Indiana, Union Township, their agents, employees, representatives, and assigns from any liability for any loss, claim, expense, and /or property damage of any kind arising from the participation in the Parade.  Please complete this registration and return with the $5.00 entry fee by September 9th 2008.

Name of entrant or organization_______________________________________

Address_______________________City__________________Zip____________

Phone__________________Number of participants________________________

Name of contact person______________________________________________

Phone________________________

Signature_______________________________Date signed_________________