Non-Profit Organizations Application Form 

Application Deadline July 15, 2010
Please complete the application form below, once we have received your online application, a representative will contact you to obtain payment for the non-profit organization booth. We must receive a copy of your 501c certification if this is your first year participating in the Midwest Regional Black Family Reunion. The application process is not complete until payment is received in full. Please remember, once fees are paid, there will be no refund.

If you do not wish to complete the application process online, you can also print this page, complete the application and mail it along with your check to Midwest Regional Black Family Reunion - PO Box 46929 Cincinnati, OH 45246-029. Make checks payable to Black Family Reunion.  

If you have any questions please contact Bettye Brock at betbrock@fuse.net. 

Note: The non-profit space in the tunnel is being eliminated for the year 2009.  We are offering tents (10x10) that will be located throughout the park.  The cost for individual tent:

        $ 300.00            Non-Profit

        $ 500.00            Non-Profit, Government
PRINT APPLICATION

* denotes required field
Organization Name: *
Contact Name: *
Address: *
City: * State: *
Zip: * Phone: *
Fax: Best time to Call: *
Email:
         
Description of items to be distributed/sold: *
         
Heavy Equipment on site:
         
Electrical Outlet:
Invoice Organization:
Name/Address:
Purchase Order:
Tax Exempt: *
Tent Type Choice: *

Sharing Tent - 10 x 10   

 Individual Tent - 10 x10

If you are sharing a tent, please complete a second application for that organization.
Does your organization carry liability insurance?: Yes No
     
Please make check payable and mail to: CyberVillage/Black Family Reunion C/O Cassandra Robinson

HOLD HARMLESS CLAUSE
The organization volunteers agree to protect, defend, hold harmless Radio One, Cybervillage USA, Inc. and CassCan Enterprises, Inc. from any and all claims, expenses, actions, causes of action, costs, damages, and from any and all acts of CyberVillage USA, Inc. and CassCan Enterprises, Inc., its agents, employees, licenses, invitees that result in injury to persons or damage to property while serving as a volunteer for the Midwest Regional Black Family Reunion Celebration.