Fields marked with an * are required fields

First Name:*
Last Name:*
Street Address:*
City:*
State:*
Zip code:*
Phone #:*
Group or Business:
E-mail address:*

1. Please select the individual you will be  re-enacting:* Select One Settler/Militia Native American Sutler 2. Do you have an authentic type of tent or shelter?* Select One Yes No 3. Are your sleeping quarters a separate shelter?* Select One Yes No 4. Will you be presenting a demonstration/seminar?* Select One Yes No

Please provide an emergency contact name and telephone number:*

Please describe the subject of your demonstration/seminar (if  applicable):

For Sutlers: Please provide a description of your merchandise

Please send color photographs of your clothing, shelter, and merchandise with  completed application.

I have read the application and agree to abide by its conditions. I  understand the authenticity committee reserves the right to examine merchandise,  accoutrements, and clothing. Items not meeting authenticity requirements will need to be changed or removed.

Signature:

Any correspondence should be mailed to:

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