OFFICIAL CONTESTANT APPLICATION FORM

1. Red Chili________
2. Salsa____________
3. Chili Verde_______
4. Homestyle________

Circle one or more of the above you will be cooking.

Cookoff Name:

2nd Annual Christmas In The Village of Powhatan

Chili Cookoff

Date: Saturday, November 14, 2015

Contestant Name _______________________________________

ICS Membership Number:________________________________

Life________Charter______ Homestyle____ Applied for_______

Expiration date __________________________________

Business Address City____________________________State_____Zip_________

Home Address City____________________________State______Zip________

Mobile Phone ( ) ____________________________________

Residence Phone ( )__________________________________

Fax ( ) _____________________

Email________________________________________________

_____________________________________________________

Team Name

_____________________________________________________

(any use of commercial business names require prior approval of Cookoff Chairperson and/or ICS)

List in detail any planned activities _____________________________________________________________________________

Will you be sponsored by anyone? Yes No If yes, fully disclose who and all

details ____________________________________________________

_______________________________________________________________________________________________________________________________________________________________

The above information is correct to the best of my knowledge. I have read the International Chili Society official rules and regulations and I hereby agree to abide by such rules and regulations or risk disqualification.

Signed & Date____________________________________________

Accepted By Date ________________________________________

Cookoff Chairperson

Entry Fee:

$40.00 /Member

$90.00 /Non-Member

1 gal in addition to entry /PC

For More Information, Contact:

Rev William Coker

103 German Hill Rd

Powhatan Point, OH 43942

740-472-4105

[email protected]

Would you like to enter this contest? Sign Up Here!

http://chilicookoff.com