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Christmas In The Village of Powhatan 

15th Annual

Saturday, November 13th, 2021

Nonprofit Organization

CHRISTMAS IN THE VILLAGE OF POWHATAN

P.O. BOX 156

POWHATAN POINT, OHIO 43942  

AMUSEMENT APPLICATION

EVENT: 13th ANNUAL CHRISTMAS IN THE VILLAGE OF POWHATAN

DATE: NOVEMBER 10th, 2018 (SECOND SATURDAY IN NOVEMBER)

TIME: FESTIVAL OPENS AT 10:00 AM AND CLOSES AT 5:00 PM

LOCATION: POWHATAN POINT MARINA

OUR SINCERE THANKS FOR HELPING MAKE OUR FESTIVAL ONE OF THE FINEST IN THE VALLEY!

PLEASE RETURN THE BOTTOM PORTION BY September 03, 2018.

CONTACT PERSON: SUZANNE HENDERSHOT_________740-391-9589 

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AMUSEMENT APPLICATION

  • NAME________________________________________________________
  • BUSINESS NAME________________________________________________________
  • ADDRESS
  • PHONE NUMBER_____________________________________________
  • CELL PHONE NUMBER________________________________________
  • E-MAIL ADDRESS___________________________________________________
  • I WILL PARTICIPATE_________________
  • I WILL NOT PARTICIPATE_____________
  • TIME YOUR AMUSEMENT WILL BE OPEN:
  • FROM__________________TO________________________
  • CERTIFICATE OF INSURANCE MUST ACCOMPANY THIS APPLICATION
  • DESCRIPTION Of PARTICIPATION:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

 I AGREE TO HOLD CHRISTMAS IN THE VILLAGE OF POWHATAN, INC., ITS’ OFFICERS AND ASSOCIATES HARMLESS FROM ANY AND ALL LIABILITIES.

SIGNATURE______________________________________________________

PRINT___________________________________________________________

DATE_________