Quartzsite Improvement Association
43rd Annual Pow Wow Gem & Mineral Show
January 21 - 25, 2009
928-927-6325
Vendor Application
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Vendor Space Application - 43rd Annual QIA Pow Wow Gem & Mineral Show - January 21 - 25, 2009 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