Form Center

2. Resource Booths Wanted!

   Organizations offering networking and resource opportunities for families dealing with or learning more about substance use prevention are invited to host a resource booth during the event. Sales such as fundraising or raffles are permitted provided, they support organizations and/or causes that have a focus on preventing substance use. 

4. Name of Organization:
6. Phone Number:
8. Email Address:
10. For promotion and advertising, please describe what you will have at your table.
12. Table*
    -- Select One --I need a table.I will bring my own table.
13. Chairs*
    -- Select One --I need 1 chair.I need 2 chairs.I will bring my own chair(s).
15. TERMS OF FACILITY USE. The User understands and agrees to all of the following terms of use:
    • The sale, possession, consumption, and use of tobacco, marijuana, and illegal drugs are forbidden in the Facility and on its grounds (parking lots, walkways, etc.).
    • User is responsible for clearing the space after the event. All trash should be removed and surfaces should be cleaned.
    • User shall not create any nuisance or disturb the event activities.
    • User is responsible for the cost of all repairs to the event facility required as a result of damage caused by User or User’s employees, agents, contractors, licensees, guests, or invitees.
    • Vehicles are not permitted anywhere other than in designated parking spaces outside the event facility.
    • Minors (persons 17 years or under) must be accompanied by adults. There shall be at least 1 adult over 18 years of age for every 8 minors for the duration of the event.
    • User is responsible for all actions of its participants and guests;
    • User that is in violation of the foregoing terms of use will be expected to immediately vacate the premises.
17. INJURIES TO PERSONS AND LOSS OR DAMAGE TO PROPERTY.

    The event presenters are not liable for any injury to persons or loss or damage to private property which occurs during the event. 

19. IDEMNIFICATION AND HOLD-HARMLESS.

    User agrees to indemnify and hold the event presenters, their officers, agents, and employees, harmless from any loss or liability which may result from claims of injury to persons or property from any cause arising out of or during the use and occupancy of the event facility by User and User’s employees, agents, contractors, licensees, guests, and invitees. 

21. ACCEPTANCE OF RULES AND HOLD-HARMLESS CLAUSE.

    1. YES, I understand and agree.
    2. NO

    By choosing "YES, I understand and agree" and typing my name below, I confirm that I am acting on my own behalf and also acting on behalf of the named organization, being fully authorized to do so, hereby waive and release any and all claims against the event presenters, together with its various departments, employees, officers, elected officials, agents, and any and all other persons or entities acting on its behalf, from any and all actions of any nature whatsoever asserting any injury, accident, harm, loss, damage, or cost arising in connection with the participating in the event, and further undertake to defend and indemnify all of the aforesaid parties against any and all such claims and forever hold them harmless from the same. I also certify that I have read this form and that all information stated herein is true to the best of my knowledge, information, and belief.

23. TYPED NAME OF USER*

    Typing your name in this field acts as your electronic signature for purposes of this form.

25. VERMONT PUBLIC RECORDS LAW

    Under Vermont's Public Records Act, 1 V.S.A. §§ 315-320, any person has the right to request inspection or copying of a public record from government agencies, including municipalities. 

    Documents in the possession of public officials for municipal business are classified as public records and are available to the public unless excluded under the Public Records Act. 

    Applicants are discouraged from submitting information considered proprietary, trade secrets, or confidential.

    Please note, some information in a public record may be redacted, narrowed, or denied in accordance with State law if it could reasonably be expected to constitute an unwarranted invasion of personal privacy (e.g. email address, phone number).

Leave This Blank:


27. Submit

* indicates a required field