Saturday, October 29 2016 Place: AutoNation Chevrolet 5757 Lake

Saturday, October 29th 2016
Place: AutoNation Chevrolet
5757 Lake Worth Road
Greenacres, FL
Rain or Shine
Vendor Information
First Name: _______ Last Name: __________________
Email Address: ___________________________
Phone : ____________________________
Address:_________________________________ City: ____________________ Zip: ________
Business Information
Company: ____________________________________________
Address:_________________________________ City: ____________________ Zip: ________
Phone_______________________
E-Mail: _______________________________________
Website: ______________________________________________________________________
Exhibutor Space 10x10: ____________ @ $25/space = ________________
Exhibutor Space 10x20: ____________ @ $40/space = ________________
Total
___________
Make Checks Payable to: CCPB. Mail to: CCPB, ℅ Lynda Campisi (Treas), 4242 Hemlock St,
Palm Beach Gardens, Fl. 33410. For more information please contact the event chairman Keith
Johnson at (561) 509-6247 or email: Kjacy@comcast.net
Signature _____________________________________________________Date____________