2. 
3. Community Day Vendor Application

   Please complete the form below to apply as a vendor for the Upper Providence Township 2022 Community Day Celebration.

   • Date: Saturday, September 17, 2022 (RAIN or SHINE)
   • 5k Race and 1 Mile Family Fun Run/Walk Start Time:  9:00 a.m.
   • Activities and Games Start Time:  11:00 a.m. – 3:00 p.m.
   • Location Rose Tree Park, 1671 N. Providence Road, Media
   • Vendor Forms are Due By: August 26, 2022

   You may upload the following REQUIRED forms below:

   • SIGNED Vendor Terms & Conditions
   • Insurance / Waiver of Liability naming Upper Providence Township and Rose Tree Park as additionally insured
   • Food Vendors - Department of health Certificate

   
   

5. Organization / Business*
6. Contact Person (Name)*
8. Contact Person Phone*
9. Email*
11. Physical Address of Business / Organization*
13. City*
14. State*
15. Zip Code*
17. Mailing Address

    (if different from physical address)

19. City
20. State
21. Zip Code
23. Website
25. Your Business Category*

    Please check the appropriate category and charges. ALL applications MUST include a certificate of insurance/waiver of liability naming Upper Providence Township and Rose Tree Park as additionally insured.

    1. Craftsperson/Business/Non-Profit - $25.00 for a 10x10; $50.00 for a 10x20 space. Applicants must provide their own tent, table, chairs and extension cords (if needed).

    1. Food Vendor/Food Truck - $150.00 – Department of Health Certificate required. Applicants must provide their own tent, tables, chairs and extension cords (if needed).
27. Craftsperson / Business / Nonprofit

    Please provide a description of the services your organization provides

28. Food Vendor / Food Truck

    Please provide a description of the food that will be offered

30. Payment Instructions

    Make checks Payable to “Upper Providence Township”.  Applications will not be considered complete without payment and a certificate of insurance/waiver of liability.

    
    

    Applications and payment can be sent via U.S. Mail or submitted in person. The Township Business hours are Mon-Fri 8:30 am to 4:30 pm., except for Holidays.

32. Signature*

    1. I have read and agree to the terms as outlined in the Vendor Terms and Conditions
    2. I have uploaded the required forms
    3. I will submit payment and understand that failure to do so will void this application
33. Your Name *
37. Upload Required Forms
    • SIGNED Vendor Terms & Conditions
    • Insurance / Waiver of Liability naming Upper Providence Township and Rose Tree Park as additionally insured
    • Food Vendors - Department of health Certificate
39. Sign & Return Vendor Terms & Conditions Form
    • You must sign and return the Vendor Terms and Conditions Form HERE.
    • Applications without a signed Vendor Terms and Conditions Form will not be accepted.
40. Upload Signed Vendor Terms & Conditions Form*
42. Upload Insurance / Waiver of Liability*

    Insurance / Waiver of Liability must name Upper Providence Township and Rose Tree Park as additionally insured

    
    

43. Upload Department of Health Certificate

    Food Vendors Only

Leave This Blank:


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

    This field is not part of the form submission.

47. Submit

* indicates a required field