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Registration Form for 2011

September 9, 10, 11, 2011

Name:

Address

Address 2

City

Phone

State

Zip

Cell

Group or Business

E Mail Address

Settler

Native

Will you be camping ?

Sutler

Yes

No

Emergency Contact Name and Phone No.

If you have not been juried before please send photos of yourself (and family). If you are a sutler please include photos of your wares and set up. Thank You.

I have read the above application and agree to abide by the conditions set forth by The Painted Stone Settlers and Shelby County Parks.

I understand that a committee will jury my clothing, accoutrements and any merchandise and can ask that I remove them if they do not comply with Painted Stone Settlers Guidelines.

PLEASE NOTE: Although online registration is encouraged and appreciated - you will still have to sign a waiver when you arrive at the camp site. Thank You

To mail correspondence:

The Painted Stone Settlers, Inc
P.O. Box 1381
Shelbyville, KY 40066-138

Email Correspondence:

kacummings@bellsouth.net

Click Here for a printable form to mail

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Painted Stone Settlers, Inc.

All photos - © Jim Cummings & Property of Jim Cummings