2. Business Name
3. Tax ID#
5. Name*
6. Email*

   Please note: emails from the City of Derby are sometimes filtered to junk mail or unable to send to Gmail addresses.

8. Address*
9. City*
10. State*
12. Zip Code*
13. Phone Number*
14. Power Needed*

    1. Yes
    2. No
16. How did you learn about this event?*
18. Detailed description of handcrafted/original artworks*
20. Booth/Art Photo*
21. Booth/Art Photo*
22. Booth/Art Photo*
24. Photo Use*
    -- Select One --YesNo

    The City of Derby has permission to use uploaded photos for event promotion if I am selected as a featured artist.

25. Comments
27. Website URL and/or social media handles for event promotion purposes.
28. Event Availability. Select all that apply.*

    1. April 18, 2024
    2. May 16, 2024
    3. Other

    We will choose one date from the dates you have selected. Use the comment box to let us know your first choice.

30. Additional Information/Special Requests
32. Booth Fees

    Booth fee is $25. You will be emailed a payment link prior to participating in the event. 

    Upon approval you can mail a check to the address below. Please note, if we are unable to hold the event due to extreme inclement weather, artist fees will be refunded. Artist fees will not be refunded for any other reason. In case of inclement weather the event will move indoors to the The Venue unless weather is deemed severe by event coordinator.

34. Pay by Check

    Make checks payable to: City of Derby 

    Mail to: 
    City of Derby Attn: Jenay Wallace
    611 Mulberry Rd. Suite 300 
    Derby, KS 67037

36. Release
    In consideration of my participation in this activity, I hereby release and discharge the City of Derby and all persons connected with this activity from any and all issues arising from illness, injuries and damages I may suffer as a result of my participation in this activity. I also understand that the City of Derby is not responsible for any cost incurred for medical services while participating in this activity, or loss of merchandise while exhibiting. I acknowledge that I have read and understand the rules and regulations concerning this activity.
38. Release Consent

    1. Yes
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field