2. Community Informational Booth Application
   We invite your group to be a part of the Blaine Block Party! The Block Party is a festive and interactive way for residents to explore their city and services. As a group that serves residents in the city, you are invited to have a free table space at the event. Please complete the form below. Groups must be non-profit, non-political, and non-religious.
4. Organization Name*
6. Contact Name*
7. Email Address*
9. Address*
11. City*
12. State
13. Zip Code*
15. Phone Number*
16. Website
18. Brief description of your organization/display*
20. What size space do you need*

    1. 4 foot
    2. 6 foot
    3. 8 foot
    4. other
22. If other, please explain the size you need.
24. Do you need a table?

    1. No
    2. 4 foot
    3. 6 foot
    4. 8 foot
25. Do you need chairs? If yes, how many?

    1. No
    2. 1
    3. 2
    4. 3
    5. 4
27. Do you need electricity?

    1. Yes
    2. No
28. Do you need access to WiFi?

    1. Yes
    2. No
30. Do you prefer to be inside or outside?

    1. Inside
    2. Outside
32. CONSENT TO RELEASE OF INFORMATION & RELEASE OF LIABILITY
    In consideration of your accepting this application, I authorize the City of Blaine to disclose to the City’s insurer, attorney, staff, coaches, participants and other personnel involved in this program the following information: name, address and telephone number. This information shall be used for the purpose of program administration. This consent to release information shall expire one year from the date of execution. I understand that the records are protected under the state and federal privacy regulations. I also understand that I may cancel this consent by a writing to that effect at any time prior to the information being released. I give my consent to use any photograph or video tape taken of myself for future promotional or marketing materials. In consideration of the City providing the registered activities, I agree to not hold the City liable for any claim resulting from participation in any such activity, including claims for injuries, death and resulting attorney fees. The completion of your registration signifies your acceptance of this consent.
34. By checking this box, you agree to the waiver and liability clause above. *

    1. I agree
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field