Mid-South Contestants Application

Mid-South Cheese Dip Classic Contestant Application TBA In order to reserve your space, please complete the following form. Copy of Application can be emailed to john@cheesedip.net
Contestant Information
First name*
Last name*
Organization*
Address*
City
State
Zip*
Phone*
Email*
Team Name
Team Captain/Head Chef
Sign To Read
Contact Person
Type of Cheese Dip with Brief Description
Does your recipe contain meat?
If so, What type(s)?
Source of power/cooking
What Division are you entering?
Number of people assigned to work in booth?
Special Needs:

Donation Type	One Time Recurring
Donation frequency
Number occurrences
	Fees	$125.00 [ Entry Fee Professional ] $100.00 [ Entry Fee Amateur ] $75.00 [ Additional Booth ] $75.00 [ Additional Booth ]
Credit Card Number*
Expiration Date*	/
Card (CVV) Code*
Card type*
Card Holder Name*
Bank ABA Routing Number*
Bank Account Number*
Bank Account Type*
Bank Name*
Account Holder Name*
I accept the Rules and Categories

Mid-South Cheese Dip Classic Contestant Application