Arizona Equipment Safety Partnering Roadeo Registration Form Vendor registration is $450 (includes a booth, 2 Attendees and your Logo on the Event T-Shirt) Online registration for the Roadeo must be submitted by March 15th, 2013 STATEMENT OF LIABILITY I understand that the Equipment Roadeo involves the movement and operation of large and powerful items of equipment.  I also understand that there are risks associated with  participating in, observing and attending the Roadeo.  I hereby release and hold harmless the State of Arizona, its employees, officers, agents and contractors from all claims, liability and rights of actions  for any personal injury and property damage, regardless of the cause, arising from my attendance or participation of the Roadeo.  I understand that this release of liability shall apply to any claims that may accrue to myself, my heirs, my estate, my personal representative, and anyone else claiming on my behalf of myself, my estate or my heirs. I agree to these terms and conditions INDEMNIFICATION Vendors: All vendors attending the Roadeo must sign this waiver at the event.   VENDOR INFORMATION Company: Contact Person :   Title: Address: City:    State:    Zip: Phone:   Cell:  Email: Logo on file: Yes No  If No, please submit to John Trojanovich by March 15, 2013. LEVEL OF PARTICIPATION: Participating Vendor - $450 (includes Booth, 2 Attendees, & Logo on Event T-Shirt) Non-Participating T-Shirt Sponsorship - $150 (includes Logo on Event T-Shirt) ATTENDEE INFORMATION ATTENDEE 1 ATTENDEE 2 First Name: First Name: Last Name: Last Name: Will you be attending the Awards Banquet: Will you be attending the Awards Banquet: No Yes   Entree Choice: Select One Chicken Steak None No Yes   Entree Choice: Select One Chicken Steak None T-Shirt: T-Shirt: Men's   Women's    Size: Select One Small Medium Large XL 2XL 3XL 4XL 5XL None Men's   Women's   Size: Select One Small Medium Large XL 2XL 3XL 4XL 5XL None 1ST ADDITIONAL ATTENDEE $65 2ND ADDITIONAL ATTENDEE $65 First Name: First Name: Last Name: Last Name: Will you be attending the Awards Banquet: Will you be attending the Awards Banquet: No Yes   Entree Choice: Select One Chicken Steak None No Yes   Entree Choice: Select One Chicken Steak None T-Shirt: T-Shirt: Men's   Women's    Size: Select One Small Medium Large XL 2XL 3XL 4XL 5XL None Men's   Women's    Size: Select One Small Medium Large XL 2XL 3XL 4XL 5XL None 3RD ADDITIONAL ATTENDEE $65 4TH ADDITIONAL ATTENDEE $65 First Name: First Name: Last Name: Last Name: Will you be attending the Awards Banquet: Will you be attending the Awards Banquet: No Yes   Entree Choice: Select One Chicken Steak No Yes   Entree Choice: Select One Chicken Steak T-Shirt: T-Shirt: Men's   Women's    Size: Select One Small Medium Large XL 2XL 3XL 4XL 5XL None Men's   Women's    Size: Select One Small Medium Large XL 2XL 3XL 4XL 5XL None If you have more than 4 additional attendees please contact Jamila Sifuentes at 602.712.8726 BOOTH INFORMATION Please identify the amount of space (in feet) you will need inside, outside or both. Inside space feet   Outside space feet BOOTH CHECKLIST Please identify all items to be utilized in your booth.     Banner Yes No Tables Yes No Provided by None Vendor Qty 0 1 2 3 4 5 6 7 8 9 10     Provided by None Event Vendor Barricades Yes No Traffic Barrels Yes No Qty 0 1 2 3 4 5 6 7 8 9 10 Qty 0 1 2 3 4 5 6 7 8 9 10 Provided by None Event Vendor Provided by None Event Vendor Barrier Wall Yes No Trash Cans Yes No Qty 0 1 2 3 4 5 6 7 8 9 10 Qty 0 1 2 3 4 5 6 7 8 9 10 Provided by None Event Vendor Provided by None Event Vendor Canopy Yes No Water & Ice Yes No Qty 0 1 2 3 4 5 6 7 8 9 10 Provided by None Event Vendor Provided by None Event Vendor     Chairs Yes No     Qty 0 1 2 3 4 5 6 7 8 9 10     Provided by None Event Vendor     VENDOR PROVIDED EQUIPMENT AND RAFFLE ITEMS Item 1 Item 2 Qty 0 1 2 3 4 5 6 7 8 9 10 Qty 0 1 2 3 4 5 6 7 8 9 10 Use for Select One Display Event Inspection Raffle Use for Select One Display Event Inspection Raffle Transport to event Select One By ADOT By Vendor Transport to event Select One By ADOT By Vendor Item 3 Item 4 Qty 0 1 2 3 4 5 6 7 8 9 10 Qty 0 1 2 3 4 5 6 7 8 9 10 Use for Select One Display Event Inspection Raffle Use for Select One Display Event Inspection Raffle Transport to event Select One By ADOT By Vendor Transport to event Select One By ADOT By Vendor Item 5 Item 6 Qty 0 1 2 3 4 5 6 7 8 9 10 Qty 0 1 2 3 4 5 6 7 8 9 10 Use for Select One Display Event Inspection Raffle Use for Select One Display Event Inspection Raffle Transport to event Select One By ADOT By Vendor Transport to event Select One By ADOT By Vendor Item 7 Item 8 Qty 0 1 2 3 4 5 6 7 8 9 10 Qty 0 1 2 3 4 5 6 7 8 9 10 Use for Select One Display Event Inspection Raffle Use for Select One Display Event Inspection Raffle Transport to event Select One By ADOT By Vendor Transport to event Select One By ADOT By Vendor Item 9 Item 10 Qty 0 1 2 3 4 5 6 7 8 9 10 Qty 0 1 2 3 4 5 6 7 8 9 10 Use for Select One Display Event Inspection Raffle Use for Select One Display Event Inspection Raffle Transport to event Select One By ADOT By Vendor Transport to event Select One By ADOT By Vendor   Total Due: $0.00   Be sure to print a copy of your registration form and attach a check or money order made payable to Organized Affair (Equipment Roadeo) and submit to Organized Affair, Attn: Michelle Fulcher, 28248 N. Tatum Blvd. Suite B1 #413, Cave Creek, AZ 85331. If you have questions contact Donna LaGuardia at 602.712.6645.