Name of Exhibitor: Mailing Address: City: State: Zip: Phone Number: Email Address:

FOR JUNIOR EXHIBITORS ONLY Birthdate: Grade Level: Club/Chapter or Name of School:

Leave Blank	Division Number	Class Number	Description of Entry (Name, Variety, Etc.)

Please accept the entries (property) described herein. I am the owner of the property specified herein or the supervisor of the project with authorization to act as agent and to bind the owners of the property in all matters herein. I have read, understand and agree to abide by all rules and regulations governing the fair entries as published in the official Premium Book including State Rules. I agree to indemnify, defend and hold harmless the fair, its officers, agents and employees from any and all claims and losses accruing or resulting to any and all persons in connection with my participation in the Fair and from any and all claims and losses accruing or resulting to any person, firm or corporation who may be injured as a result of my participation.

Initials of Exhibitor: Date:

I certify that this entry is the project/exhibit or the exhibitor and these entries comply with the rules and regulations published in the official premium book and including State Rules.