Chef Participation Response Form

PA Preferred Best Chef of Pennsylvania Competition – Northeast Region

to take place at the 2006 Pittston Tomato Festival, Pittston, PA

August 19^th and 20^th

I, _______________________________________________, wish to participate in PA Preferred Best Chef of Pennsylvania Competition – Northeast Region and I agree to be assigned a competition slot to be scheduled between 12:00 pm and 5:00 pm on Saturday, August 19. Should you proceed to the second and final rounds, you will be assigned to compete between 12:00 pm and 5:00 pm on Sunday, August 20. I also grant permission for my recipe, created during the PA Preferred Best Chef of Pennsylvania Competition – Eastern Region, and its photo image to be posted on Internet.

DIRECT CONTACT INFORMATION

Name of Participating Chef: ____________________________________________________________________________

Title: _______________________________________________________________________

Address for Correspondence:  ____________________________________________________________________________

City______________________State___________________________Zip_________________

Business Phone:   ____________Home Phone: __________________ Fax: ________________

Cell Phone:  ________________________E-mail:  ___________________________________

RESTAURANT AND BIOGRAPHIC INFORMATION

Restaurant Name:              

____________________________________________________________________________

Restaurant Address:

 ___________________________________________________________________________

City______________________State_______________________Zip_____________________

Phone:    ______________________ Fax: __________________________________________

BIOGRAPHIC INFORMATION____________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

PARTICIPATION AGREEMENT

Upon accepting this invitation, I grant permission for my name and biographic information to be used in this event’s advertising and publicity campaign, including, but not limited to, broadcast media, print advertising, web site listings, and marketing brochures.

_____________________ ____________________

Signature                                                                                                                                               Date

Please complete and return this form to:

Marjann Young

PA Restaurant Association

100 State Street

Harrisburg, PA 17101

p: 717.232.4433; f: 717.236.1202

Marjann@parestaurant.org