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Event Vendor Registration

2. Name of Special Event*

   Please type the name of the special event you will participating in.

4. Will you be participating one day or multiple days?*
   -- Select One --One DayMultiple Days

6. Which Day*
   Which Day

7. Which Days?*
   Which Days? Start Date

   —

   Which Days? End Date

9. Are you a business or and individual?*
   -- Select One --IndividualBusiness

11. First Name*

12. Last Name*

14. Address1*

16. Address2

18. City*

19. State*

20. Zip*

22. Name of Business*

24. Address1*

26. Address2

28. City*

29. State*

30. Zip*

32. Contact Name*

33. Contact Phone Number*

35. Are you licensed with the City of Waukegan?*
    -- Select One --YesNo

37. Please provide Account Number

38. Please provide License Number

40. What city are you licensed in?*

42. What type of vendor will you be?*

    Check all that apply.

    1. Food
    2. Merchandise
    3. Service
    4. Informational
    5. Entertainment
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field