HCBF BEER/MEAD/CIDER VENDOR REGISTRATION

Deadline to register or update your registration has passed. Submissions no longer accepted at this time.

Type:*	Brewery Shop Homebrew Club
Vendor Name:*
Contact Person:*
Street Address:*
City:*
State:*
Zip:*
Telephone:*
E-mail address:*
E-mail address #2:
E-mail address #3:
Brewery Web Site	(Do not include "http://")

List Brewery Representatives Attending
(please indicate if an attendee is your Head Brewer)

Rep 1:*
Rep 2:
Rep 3:
Rep 4:

Hotel: No
Name for the reservation:
Room Type:
Nights Needed:


Beer Information (at least one required)

Brewery Name:
Beer Name #1:
Beer Style:
Beer Category:	Choose One Amber Belgian Blonde Brown Cider Dark European Lager Fruit Hoppy Malty Mead Sessionable Roasty Smoked Sour Specialty Spiced Strong Wheat Wood-Aged (Choose the one category that best matches this beer)
Beer ABV:
Quantity:
Brewery Name:
Beer Name #2:
Beer Style:
Beer Category:	Choose One Amber Belgian Blonde Brown Cider Dark European Lager Fruit Hoppy Malty Mead Sessionable Roasty Smoked Sour Specialty Spiced Strong Wheat Wood-Aged (Choose the one category that best matches this beer)
Beer ABV:
Quantity:
Brewery Name:
Beer Name #3:
Beer Style:
Beer Category:	Choose One Amber Belgian Blonde Brown Cider Dark European Lager Fruit Hoppy Malty Mead Sessionable Roasty Smoked Sour Specialty Spiced Strong Wheat Wood-Aged (Choose the one category that best matches this beer)
Beer ABV:
Quantity:
Brewery Name:
Beer Name #4:
Beer Style:
Beer Category:	Choose One Amber Belgian Blonde Brown Cider Dark European Lager Fruit Hoppy Malty Mead Sessionable Roasty Smoked Sour Specialty Spiced Strong Wheat Wood-Aged (Choose the one category that best matches this beer)
Beer ABV:
Quantity:
Brewery Name:
Beer Name #5:
Beer Style:
Beer Category:	Choose One Amber Belgian Blonde Brown Cider Dark European Lager Fruit Hoppy Malty Mead Sessionable Roasty Smoked Sour Specialty Spiced Strong Wheat Wood-Aged (Choose the one category that best matches this beer)
Beer ABV:
Quantity:
Brewery Name:
Beer Name #6:
Beer Style:
Beer Category:	Choose One Amber Belgian Blonde Brown Cider Dark European Lager Fruit Hoppy Malty Mead Sessionable Roasty Smoked Sour Specialty Spiced Strong Wheat Wood-Aged (Choose the one category that best matches this beer)
Beer ABV:
Quantity:
Brewery Name:
Beer Name #7:
Beer Style:
Beer Category:	Choose One Amber Belgian Blonde Brown Cider Dark European Lager Fruit Hoppy Malty Mead Sessionable Roasty Smoked Sour Specialty Spiced Strong Wheat Wood-Aged (Choose the one category that best matches this beer)
Beer ABV:
Quantity:
Brewery Name:
Beer Name #8:
Beer Style:
Beer Category:	Choose One Amber Belgian Blonde Brown Cider Dark European Lager Fruit Hoppy Malty Mead Sessionable Roasty Smoked Sour Specialty Spiced Strong Wheat Wood-Aged (Choose the one category that best matches this beer)
Beer ABV:
Quantity:
Brewery Name:
Beer Name #9:
Beer Style:
Beer Category:	Choose One Amber Belgian Blonde Brown Cider Dark European Lager Fruit Hoppy Malty Mead Sessionable Roasty Smoked Sour Specialty Spiced Strong Wheat Wood-Aged (Choose the one category that best matches this beer)
Beer ABV:
Quantity:
Brewery Name:
Beer Name #10:
Beer Style:
Beer Category:	Choose One Amber Belgian Blonde Brown Cider Dark European Lager Fruit Hoppy Malty Mead Sessionable Roasty Smoked Sour Specialty Spiced Strong Wheat Wood-Aged (Choose the one category that best matches this beer)
Beer ABV:
Quantity:
Brewery Name:
Beer Name #11:
Beer Style:
Beer Category:	Choose One Amber Belgian Blonde Brown Cider Dark European Lager Fruit Hoppy Malty Mead Sessionable Roasty Smoked Sour Specialty Spiced Strong Wheat Wood-Aged (Choose the one category that best matches this beer)
Beer ABV:
Quantity:
Brewery Name:
Beer Name #12:
Beer Style:
Beer Category:	Choose One Amber Belgian Blonde Brown Cider Dark European Lager Fruit Hoppy Malty Mead Sessionable Roasty Smoked Sour Specialty Spiced Strong Wheat Wood-Aged (Choose the one category that best matches this beer)
Beer ABV:
Quantity:
Brewery Name:
Beer Name #13:
Beer Style:
Beer Category:	Choose One Amber Belgian Blonde Brown Cider Dark European Lager Fruit Hoppy Malty Mead Sessionable Roasty Smoked Sour Specialty Spiced Strong Wheat Wood-Aged (Choose the one category that best matches this beer)
Beer ABV:
Quantity:
Brewery Name:
Beer Name #14:
Beer Style:
Beer Category:	Choose One Amber Belgian Blonde Brown Cider Dark European Lager Fruit Hoppy Malty Mead Sessionable Roasty Smoked Sour Specialty Spiced Strong Wheat Wood-Aged (Choose the one category that best matches this beer)
Beer ABV:
Quantity:
Brewery Name:
Beer Name #15:
Beer Style:
Beer Category:	Choose One Amber Belgian Blonde Brown Cider Dark European Lager Fruit Hoppy Malty Mead Sessionable Roasty Smoked Sour Specialty Spiced Strong Wheat Wood-Aged (Choose the one category that best matches this beer)
Beer ABV:
Quantity:

Special Tappings
Indicate Name of Beer, style, and time of day (between 1:30pm and 4:30pm) you will pour. This will get a special mention in the PassPort that each patron receives.

Beer #1:
Tap Time #1:	Choose 1:30 pm 2:00 pm 2:30 pm 3:00 pm 3:30 pm 4:00 pm 4:30 pm
Beer #2:
Tap Time #2:	Choose 1:30 pm 2:00 pm 2:30 pm 3:00 pm 3:30 pm 4:00 pm 4:30 pm
Beer #3:
Tap Time #3:	Choose 1:30 pm 2:00 pm 2:30 pm 3:00 pm 3:30 pm 4:00 pm 4:30 pm
Beer #4:
Tap Time #4:	Choose 1:30 pm 2:00 pm 2:30 pm 3:00 pm 3:30 pm 4:00 pm 4:30 pm

Set-up requirements
Will your brewery provide a tent for your table?* Yes No
Will your brewery have a vehicle/trailer as part of its set-up?* Yes No

Friday reception
Will your brewery participate in the reception event Friday evening?* Yes No
Can your brewery provide beer for the reception event?* Yes No

Brewers Insurance
As required by law, all breweries/distributors must have adequate insurance coverage in order to participate per the following requirements:

• $1,000,000 each occurrence, $1,000,000 General Aggregate, $1,000,000 Product Aggregate for General Liability
• $1,000,000 each occurrence, $1,000,000 Annual Aggregate for Liquor Liability
• Workers Compensation - Florida Statutory Limits

Please confirm that you have such coverage by providing the name and contact information for your insurer:

Name:*
Contact:*

Comments/Questions: