FiestaBrevardLogo Welcome to
Fiesta Brevard 2012!
Friday, April 27th
5:30 - 9:00 PM

Register to Participate!

Non-Profit Organization Participation Registration

Thank you for participating in Fiesta Brevard 2012! Please complete the information below, and you will be contacted soon.

Contact #1 First:
Contact #1 Last:
Contact #1 Email:
Contact #2 First:
Contact #2 Last:
Contact #2 Email:
Organization Name:
Address Street 1:
Address Street 2:
City:
Zip Code:	(5 digits)
State:
Daytime Phone:
Evening Phone:
Need Electricity?
Using a Canopy/Tent?
Same Location?:
Corporate Sponsor:
Comments:	Enter comments here!
	Paying by check? You or your corporate sponsor can send a check for your $400 registration fee: Cocoa Beach Regional Chamber of Commerce c/o Fiesta Brevard 400 Fortenberry Road Merritt Island, FL 32952 321.459.2200 phone 321.459.2232 fax Please note: registration is not final until payment is received! If you prefer to pay by credit card, you will be directed to online payment options when you press "Submit" below. Please submit to the Chamber: This completed Participation Form (due no later than 2/15/12 for returning participants) $400.00 Participation Fee (returning participants - no later than 3/1/12) Logo JPG (please send to Darlene – dhight@cocoabeachchamber.com) 2 Gift Certificates/Gift Cards – please request donations from area businesses (note - your allotment of tickets will not be released until gift cards/certificates are received): One $25.00 Restaurant Gift Certificate request 4/30/13 expiration date One or more, minimum $25.00 Gift Certificate to Restaurant, Amusement, Pamper Certificate, etc. request 4/30/13 expiration date In lieu of providing above, up to $50 can be debited against your share of pooled proceeds If gift certificates are not received by March 27th, we will record the $50 debit option for you Booth Activity – turn into Chamber ASAP or notify Fiesta team for help Final booth locations will be assigned after March 1st To be fair to all, booth assignments will be first-come, first-served, with seniority rights for returning participants Please choose a volunteer to participate in our “Volunteer Pool” Thank you for your registration! We're excited you will be joining us!

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Register to Participate!