Spooky Empire’s Tattoo Festival Registration Form October 24 – October 26, 2014

Spooky Empire’s Tattoo Festival
Registration Form
October 24 – October 26, 2014
DoubleTree by Hilton at Universal
5780 Major Boulevard, Orlando, Florida 32819
You are registering for the 2014 Spooky Empires Tattoo Festival, located at Spooky Empire’s Ultimate Horror
Weekend. Please read over the below information. Sign and return the following registration form, including the
State of Florida Guest Artist Application (if applicable). This copy must be signed and returned, to confirm your
spot. Any registration forms returned without all information being filled out, will not be processed.
We do require a minimum 50% deposit. Once you submit a deposit along with this application, your spot
will be considered confirmed.
New artists are welcome to send an email with a link to their portfolio, or include pictures in the body of the
message, to tattoo@spookyempire.com. ONLY the artists approved for the show are to be tattooing at the
booths. A shop cannot bring in different artists throughout the weekend. If this occurs, all parties involved
will be ejected from the show, with no refunds given.
(Limit two approved artists per booth)
* Piercing will not be allowed to take place in the convention area.
Although we do not foresee it, current health codes could change regarding what is required to tattoo in the state of
Florida. If this were to occur, we would immediately contact everyone, informing them of the changes and any new
requirements. It is your responsibility to know how to conduct yourselves as professional tattoo artists, and
perform in a safe, sterile manner. If you do not, you will not be permitted to work at the show, and will be given no
refund.
YOU MUST HAVE CURRENT SPORE TESTING RESULTS, AS WELL AS AN ANNUAL PERMIT FOR YOUR
STUDIO (If you have questions or concerns about Orange County Health Codes, feel free to contact us.
FLORIDA REQUIREMENTS AS OF 2013:
•
If you are NOT licensed in the State of Florida, The attached State of Florida Guest Artist Registration
MUST be completed along with your application. (Florida License fee of $35, or $60 to be licensed for one
year, NOT included in your booth cost)
•
All artists must either be licensed or registered with the Florida Department of Health. If you have a Florida
License please send a copy with your application.
•
Florida Department of Health approved blood borne pathogens training is required for anyone not licensed
within the state of Florida. The online training course can be found here
http://blxtraining.com/tattoopiercing-bbp/ There is a fee to take the course, but it is a one-time test. (This
fee is not included in your booth cost)
Spooky Empire’s Tattoo Festival
Registration Form
October 24 – October 26, 2014
Please be sure to check out the Exhibitor page of the website www.spookyempire.com as all Exhibitors terms are to be
followed by tattoo artists as well.
Spooky Empire Inc. Reserves the right to refuse and refund any submitted registrations.
Company Name: _________________________________________________________
Your Name: _____________________________________________________________
Address: ________________________________________________________________
________________________________________________________________________
Website: ________________________________________________________________
Email: __________________________________@______________________________
Phone: __________________________________
Contact email(s) or website(s) you would like us to use on our website for appointments:
Name Of Artist #1 ________________________ Name Of Artist #2 _________________________
Assistant #`1___________________________ Assistant #2 ________________________________
Signature: __________________________________ Date: ____________
You can purchase a half booth for 1 artist or the full booth for 2 artists.
•
•
½ Booth space - $350
Full Booth Space - $500
Each booth space includes floor covering, two chairs, a covered table (plastic covers will be supplied per Board of
Health requirements), electricity, a sharps container, and a bio-hazard disposal, and 2 badges (additional badges
may be purchased for $25 each) Any other items needed are the responsibility of each exhibitor. All artists and
assistants must be listed below.
Anyone who is falsely using an artist badge will be ejected from the show, as well as the artist who gave it to
them. All tattoo customers MUST have purchased admission to Spooky Empire, no exceptions!
**You will have an image of your work posted on the website with a link to your
website and/or e-mail.
WE ASK THAT ALL ARTISTS ATTENDING THE SHOW BE PRESENT AND SET UP IN TIME FOR
INSPECTION BY FL DEPT OF HEALTH.
Spooky Empire’s Tattoo Festival
Registration Form
October 24 – October 26, 2014
Quantity
Item
Price
Half Booth (1 artist max)
$350
Full Booth (2 artists max.)
$500
Addt'l badges
$25/each
Vendor VIP Package
$125
Total
(Limit 2 Addt'l Per Artist)
Shirt Size(s)
(Limit 2 per Artist)
Total Due
Amount Enclosed
Balance Due
Method of Payment:
Cash
____Check
__Money Order
_____ (Made payable to: Spooky Empire, Inc.)
Credit Card: Visa or Mastercard Only
Card Number
Expiration Date
Name on Card
Billing Zip Code
Mail Payment/Application To: Spooky Empire, Inc., P.O. Box 460574 Ft. Lauderdale, FL 33346
Email Or Fax your application with credit card info to:
Email address: tattoo@spookyempire.com or
FAX: (954)337-8280
Please remember full payment or a 50 % deposit is due with signed forms must be received to confirm your
spot(s).
NO ARTISTS WILL BE POSTED ON THE SITE WITHOUT DEPOSIT/APPLICATION.
Please contact us directly at tattoo@spookyempire.com with any questions.
CHECKLIST:
PLEASE BE SURE YOU HAVE EVERYTHING LISTED HERE BEFORE SENDING TO US!
•
•
•
•
Spooky Empire Application
Dept of Health Application for Guest Tattoo Artist Application (out of state artists)
Copy of your Drivers License
Proof of Completion Bloodbourne Pathogens Training or State Licensure
DH use only: Check No.
Check
Date Received
Receipt No.
Facility Permit No.
Date Issued
Amended Application Only
Date Received
Amount
STATE OF FLORIDA
DEPARTMENT OF HEALTH
Authority 381.00775 Florida Statutes
Application for Guest Tattoo Artist Registration
Instructions: Do not leave any item blank. Enter “NA” for non-applicable items. For initial registration, submit the
completed application to the county health department that has jurisdiction for the tattooing program in the county where
the applicant practices or intends to practice tattooing. To select the county, type the following link into Internet browser:
http://www.myfloridaeh.com/community/biomedical/county_coordinators.htm. This application must be accompanied by
the following:
•
Fee of $35.00.
•
A copy of a government-issued photo identification confirming at least 18 years of age (submit for initial registration only, not
renewal).
A copy of an active license, registration, or certification in another jurisdiction (submit for initial registration only, not renewal).
A copy of a certificate of training proving completion of a course on blood-borne pathogens and communicable diseases, as
specified in ss. 64E-28.004(1)(b), F.A.C., with having achieved a minimum score of at least 70% on the course examination.
(submit for initial registration only, not renewal).
•
•
REGISTRATION IS VALID FOR UP TO 14 CONSECUTIVE DAYS.
Specify Dates: From
To
Type of Registration:
Initial
Renewal
Name of Applicant:
Residential Address of Applicant:
Street
City
State
Zip Code
City
State
Zip Code
Mailing Address if Different:
P.O. Box or Street
Phone Number (
)_____________________________
E-mail Address: ____________________@ _______________________
Provide the following information for each tattoo establishment or temporary establishment where the applicant will be
temporarily performing tattooing:
1.
________________________________________________________________________________________________
Name of Licensed Establishment
2.
Department of Health License Number
________________________________________________________________________________________________
Name of Licensed Establishment
Department of Health License Number
The undersigned Applicant hereby agrees to practice tattooing in compliance with ss. 381.00771-381.00791, F.S., and Chapter 64E-28,
F.A.C., and exclusively at an establishment licensed under ss. 381.00771-381.00791, F.S., and Chapter 64E-28, F.A.C. The information
contained in this application, which serves as a basis for registration, is true and correct. I understand that any misrepresentation of the
facts in this application, or failure to comply with sanitary standards, is grounds for denial, administrative fine and/ or revocation of the
tattoo registration. Further, I understand that obtaining or attempting to obtain a license or registration by means of fraud,
misrepresentation, or concealment is committing a misdemeanor of the second degree punishable as provided in s. 775.082 or
s.775.083.
_____________________________________________
Name of Applicant (print of type)
_____________________________________
Date
_____________________________________________
Signature of Applicant
DH 4150. 7/12
64E-28.004 F.A.C.