Chocolate Celebration Vendor Registration

DATE: 04/25/2022
LOCATION: Kokomo First Church of the Nazarene 2734 S Washington Street, Kokomo, IN 46902

For event details, check out the main Chocolate Celebration event page!

Contact us at (765) 453-7611 with any questions. Complete the participation agreement form below to print off and mail or, register online below.

REGISTRATION AND MONEY MUST BE RECEIVED BY April 25, 2022, 4PM.
$50 for 1 table, $70 for 2 tables

More information available closer to day of event, Friday, May 6, 2022.

Registration

Business Name
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Contact Name
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Mailing Address
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City
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State
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Zip Code
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Phone
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Email
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1 table for $50 or 2 tables for $70
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Cost $50 for 1 table or $70 for 2 tables
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Electricity Needed
Yes No
Please let us know if you would like the same section as last year or a new location

*I would like to reserve a vendor table/tables at Chocolate Celebration.
E-Signature (Please type name below to confirm)
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Payment Information

Pay online with the form below or download/mail this form with payment to:
Samaritan Caregivers, 2705 S Berkley Rd, Suite 3C, Kokomo, IN 46902

Payment Amount
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Name of Cardholder
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Card Type
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Credit Card Number
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CVV (Digits on back of card)
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Expiration
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Contact Information

First Name
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Last Name
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Email
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Phone
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Billing Address

Street
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City
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State
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Zip Code
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Type the letters from the image.
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