2016 Passport to Wellness

Saturday, October 1, 2016

Sales/Sponsor Booth Registration
______________________________________________________________________________
General Information:
Booth Name:_____________ ____________ Contact Name:__ _____ ____________________ ___
Address:_________________ _____________ City:_____________ State:_______ Zip:________
Phone Number: (_____)_________-_____________ Fax: (_____)_________-_____________
Email Address: ________ ___ ______@____ ____ ________________ ________._____

On-Site Contact:
Name:_______________ ______________ Phone: (_____)_______-__________
Day of Phone: (_____)_______-_________ Email: __ _ _______@_____ _____. ___

Declaration of Permits & Insurance (Retail Locations or Prior Authorization Only):

I have a permit to make sales at retail under the State of Rhode Island sales Tax and Use Tax Act. My permit ID number
is: . Please attach a copy of your State of Rhode Island Department of Revenue Permit to
this form.

Location:
[ ] Omni Providence Hotel, 1 West Exchange Street, Providence, RI 02903

Fee Schedule:
Each location will have 1 (one)-6 table, 2 (two)- chairs. Electricity is available for a nominal fee must be purchased prior to
the event date to ensure power service. Power and additional rental needs must be ordered at least seven (7) business
days prior to the start of the event. All needs that are ordered less than seven (7) days will be on a first come-first serve
basis and will be placed into a work order. Due to the amount of work to be done during the event, all on-site orders cannot
be guaranteed.

Passport to Wellness

DISCOUNTED PRICE APPLIES ONLY IF FORM AND PAYMENT IN FULL ARE RECEIVED ON OR BEFORE DECEMBER 15, 2015.

[ ] Nonprofit Organization: Suggested Donation- $100.00 (Discounted Price)

[ ] For Profit Business or organization: $280.00 (Discounted Price)
[ ] Nonprofit Organization: Suggested Donation- $125.00
[ ] For Profit Business or organization: $350.00
Electrical Needs:
______ Yes, I am in need of electrical service for my exhibit
The electrical is to run the following equipment: _______________________________________
The best person to contact if the Electrician has questions is: _____________________________
Phone Number: _____________________________
(Depending on needs, electrical may be assessed a fee. Vendor will be notified of fee upon review of form. All electrical
requests will be confirmed and approved by email to the contact listed above.)

______ No, I am not in need of electrical service for my booth (please note that all electrical requests that are made on-site
may not be able to be filled. This is an outdoor event and electrical is brought on-site by a generator.)

Day of Logistics:
Parking: Free valet parking is available the day of the event for vendors only. The Gloria Gemma Breast Cancer Resource
Foundation assumes no responsibility for cars parked through valet or other means.

On-Site Sales: On-site sales within the Passport to Survivorship and Wellness event will be allowed by vendors who submit
the appropriate forms prior to the event.

Delivery/Load-In:
Saturday, October 1, 2016
Renaissance Providence Hotel: 6:00AM to 7:00AM (Load-in time may change. Vendors will be notified prior to the event
via email).

A delivery un-loading zone will be established prior to the event (all vendors will be notified by email of official
loading/unloading rules and regulations). Please remain within this zone for less than 5minutes. All violators or
unauthorized vehicles will be towed at the owners expense.

Load-Out:
Load-Out of both Locations will be after 2:00PM (October 1, 2016). The load-out zone for pick-up will be open after 2:00PM.
Please have booth ready for pick-up prior to approaching the load-out zone. Each vendor will be allotted 5 (five) minutes
within this zone once the vehicle has been returned from valet. All violators or unauthorized vehicles will be towed at the
owners expense. Volunteers will be there to assist.

Hours of Operation:
Passport to Wellness (Omni Providence Hotel)
Passport to Wellness: 8:00AM to 2:00PM
Flame of Hope: A Celebration of Life: 4:30PM-12:00AM

-Please See Agreement on Page 3-

Agreement:
I have read and understand the above Rules & Regulations for vending/exhibiting at the 2016 Passport to Wellness at
Flames of Hope: A Celebration of Life. I agree to abide by the Rules & Regulations and assume all responsibility for
my booth/operations. All payments and requests for vending/sponsor booths must be received by the operations staff
one month prior to the event.

Agreed:_______________________ ________________ Date:______________________

Print Name:_____________________ ________________

Please fax or mail completed registration form to:

Fax: (401)305-6623
Gloria Gemma Breast Cancer Resource Foundation
Attn: Carol Ann Donnelly
249 Roosevelt Avenue, Suite 201
Pawtucket, RI 02860
or email completed form to:
carol@gloriagemma.org