QIA Pow-Wow Application Form

Quartzsite Improvement Association

44th Annual Pow Wow Gem & Mineral Show

January 20 - 24, 2010

928-927-6325

On May 1, 2008, Governor Napolitano signed Laws 2008, Ch. 152 (House Bill 2745) into law. The new law contains a "licensing eligibility" section (Arizona Revised Statutes Par. 41-1080) preventing a state agency from issuing a (new or renewed) license to an individual unless the individual has provided the agency with one of the forms of identification listed in the law.

To become or remain eligible for a license, please bring your Driver's License (Licenses from HI, IL, ME, MD, NM, TX, UT, and WA are NOT acceptable), Passport/Visa and/or birth certificate for proof of citizenship or that you are in the United States legally. Also bring your Arizona State Tax Resale certificate or number.

These documents are necessary for your participation in the Pow-Wow. Thank you very much. We appreciate you and look forward to a great year.

Vendor Application

Vendor Space Application - 44th Annual QIA Pow Wow Gem & Mineral Show - January 20 - 24, 2010

Dealer Name_________________________________________________________________________

Company Name_______________________________________________________________________

Address_____________________________________________________________________________

City, State____________________________________________________ Zip_____________________

Phone / FAX__________________________________________________________________________

Web site / e-mail_______________________________________________________________________

Merchandise (must be at least 75 % Gem & Mineral-related)

____________________________________________________________________________________

Type & Length of Vehicle_________________________________________________________________

Print this form, fill it out and mail it to QIA Pow Wow, Box 881, Quartzsite, AZ 85346-0881