NAME OF GROUP, BUSINESS OR INDIVIDUAL _________________________________________________________
ADDRESS: ________________________________________________________________________________________________
CONTACT PERSON(S): ____________________________________________________________________________________
PHONE: ___________________________________________________________________________________________________
TITLE OF ENTRY OR THEME: ____________________________________________________________________________
PLEASE CHECK ONE THAT MOST APPLIES:
INDIVIDUAL _______________ GROUP _______________ PET ____________
AND
WALKERS _______________ SMALL FLOAT _______________ LARGE FLOAT ____________
OLD TIME CARS _______________ BAND ________________
OTHER (please describe) __________________________________________________________________________________
_____________________________________________________________________________________________________________
Return to: Anthracite Heritage Festival Parade, attn: Pam Burns, 10 S. Market St., Shamokin, PA 17872 or fax to 570-644-0897.