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2. Business Name*
3. Contact*
5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
12. Email Address*
14. Business Website*
16. Social Media Links (Instagram & Facebook)
18. Business Mission*
20. What Pillar of Wellness Best Represents Your Business? (You May Select More Than One!)

    1. Emotional
    2. Environmental
    3. Mental
    4. Physical
    5. Social
    6. Spiritual
24. INTERESTED IN: (Please check all that apply)
26. Booth Space - $50 each*

    1. 6 ft rectangular table
    2. 8 ft rectangular table

    Booth registration includes 1 table & 1 chair only (please advise if not needed). Tablecloths are the responsibility of the exhibitor and will not be provided by the event organizer.

    The venue has (16) 8ft rectangular tables & (12) 6ft rectangular tables. Please specify your preference

28. Do you need electricity?*

    1. Yes
    2. No

    Limited number of spaces are available that include electricity

30. Wellness Day Sponsorships

    1. Signature Sponsor - $5,000 (Exclusive - Only 1 Available)
    2. Finish Line Sponsor - $3,000 (Exclusive - Only 1 Available)
    3. Vitality Sponsor - $1,000 (5 available)
    4. Medal Sponsor - $1,000 (Exclusive - Only 1 Available)
    5. Hospitality Tent Sponsor - $1,000 (Exclusive - Only 1 Available)
    6. Lotus Sponsor - $500 (10 Available)
    7. Friends of Middleburg Sponsor - $250 (Exclusive to Wellness Day Vendors and Town of Middleburg Businesses)

    Please send sponsorship logos to amacintyre@middleburgva.gov

32. Business Logo (AI, EPS, or SVG format)
34. Enter the Total Amount Due*
    Please make checks (or money orders) payable to the Town of Middleburg. Send to P. O. Box 187 Middleburg, VA 20118.
36. NOTICE: If you plan to sell items during the event, you will need to secure a Temporary Business License from the Town ($10/day fee).
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