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Congregation Agudath Sholom, 301 Strawberry Hill Avenue, Stamford, CT 06902

Phone: 203-358-2200 Fax: 203 358-2323

Annual Passover/Mitzvah Fair

March 27, 2011

10:00 a.m. – 2:00 p.m.

Set up: 8:00 – 10:00 a.m.

Application & Disclaimer:

We look forward to having you participate in the Passover Vendor Fair which we have coordinated. We wish you the best of luck on the day of the event.

To ensure we have all of your information correct please fill in the application below. Also, as a formality, it is important that this document be signed by you, or anyone assisting you, assuming total responsibility of your person/merchandise while at Congregation Agudath Sholom.

Please sign and return via fax (203-358-2323) or e-mail to: capple@agudathsholom.org prior to your arrival.

Thank you for your cooperation.

Sam Goldstein

Men’s Club President

Name of company Lida Elazari

Person that will be at the fair if different from above

Address 400 East 54Th St NY NY 10022

Phone # 646-554-8833 E-mail address Lidalc@yahoo.com

Category of items you will be selling Table cloth

Number of tables 1

Special requests: Wall outlets, etc.

I, , assume total responsibility for myself, my agents, and employees, and my merchandise, while I/we are on the premises of Congregation Agudath Sholom, and release Congregation Agudath Sholom and all sponsors, its officers, board members, agents, employees and volunteers from any and all claims, actions and liability of whatsoever kind or nature, arising out of or in connection with my participation in and exhibiting at the event known as Annual Passover/Mitzvah Fair.

I understand that 10% of the proceeds on all items sold or ordered will be donated to Congregation Agudath Sholom.

_____Lida Elazari______________________________ (vendor/artisan signature)

Directions To

Congregation Agudath Sholom

301 Strawberry Hill Avenue

Stamford, CT 06902-2511

(203) 358-2200

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