2012
PRAIRIE HARVEST DAYS
 FOOD BOOTH REGISTRATION

Please complete THIS FORM and return with check by September 1st to:
Stephanie Heyen
31511 ECR 1250 N
Mason City, IL 62664

The following must be included with the Prairie Harvest Days Booth Registration Form:

(a) Rental fee of $30.00 to P.H.D. (Rental must be paid in advance to reserve booth space);
(b) Liability Release (On Form)
(c) NEW Temporary Food Permit from Mason County Health Department - $20 payable to
(Below)

(Please read and fill out the County food permit CAREFULLY – There is a $25 Late fee assessed if form is not filed with Health Department THREE (3) Days PRIOR to event)

*** No booth selling any type of food or beverage will be allowed to operate without a food permit. You will be asked to leave and may have to pay the county a fine. ***

PRINT OUT ALL THREE FORMS BELOW