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2. Activity Booth Application

   Fill out the form below for an activity booth at Jurupa Valley's Tree Lighting Ceremony on December 4, 2024.

4. Contact Name:
6. Organization Name:
8. Address:
10. City:
11. State:
12. Zip Code:
14. Phone Number:
15. Email:
17. Social Handle:
18. Website:
20. 1. I plan to distribute FREE (check all that apply):

    1. Information
    2. Giveaways
    3. Product Samples
    4. Other
22. If you selected 'other', what will be distributed?
24. 2. I plan to host a FREE ACTIVITY at my booth (e.g., raffle, game, petting zoo, inflatable attraction, e.t.c.):

    Booths with active participation (e.g., petting zoo, inflatable attraction, etc.) will be required to provide certificates of liability insurance with a separate endorsement naming the City of Jurupa Valley as additionally insured.

    1. Yes
    2. No
25. Description of free activity:
27. 2a. I need a ___ foot by ______ foot space to host my ACTIVITY:
29. ACKNOWLEDGEMENT
31. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
33. Applicant Name
35. Electronic Signature
36. Date:
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field