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2. Sponsoring Business/Organization Name*
3. Business Phone
5. Business Address*
7. City*
8. State*
9. Zip*
11. Contact Name*
12. Phone *
13. Email*
15. Event*

    1. First Friday's-Powhatan
    2. Powhatan Village Farmers Market
    3. Movies in the Park
    4. Light Up Powhatan!
    5. Other
16. Sponsorship Level*
    -- Select One --First Friday: Title Sponsor ($1,200)First Friday: Band Sponsor ($500)First Friday: Friends ($100)Movies in the Park: Title Sponsor ($2,500)Movies in the Park: Event Sponsor ($1,000)Movies in the Park: Supporting Sponsor ($500)Movies in the Park: Popcorn SponsorFarmers Market: Harvest Sponsor ($4,000)Farmers Market: Cattleman Sponsor ($1,000)Farmers Market: Carrot Patch Sponsor ($500)Farmers Market: Music Sponsor ($100)Light Up Powhatan! Platinum ($5,000)Light Up Powhatan! Gold ($2,500)Light Up Powhatan! Blue ($1,000)Light Up Powhatan! Red ($500)
18. If applicable, select the date in the series you wish to sponsor.
    If applicable, select the date in the series you wish to sponsor.
19. Business/Organization Logo*
21. TERMS OF AGREEMENT

    The Sponsor agrees to provide financial or in-kind support for the Powhatan County event identified in this form in exchange for the benefits outlined in the Sponsorship Packet. 

    Payment Terms: The Sponsor will make the payment no later than 30 days before the event. 

    Event and Branding: Powhatan County agrees to use the Sponsor’s name, logo, and/or trademarks in the promotional materials for the Event as mutually agreed upon. 

    Term and Termination: This Agreement is effective as of the date this document is signed and will terminate upon the completion of the Event or when terminated earlier by either party with written notice.

    Liability Limitation: The Sponsor acknowledges that the County is not liable for any injuries, damages, or losses to individuals or property arising during the Event, except in cases of gross negligence or willful misconduct. The Sponsor agrees to hold the County harmless from any liability, claims, or legal actions resulting from the Sponsor’s participation in the Event.

    Responsibility for Own Actions: The Sponsor assumes full responsibility for the actions of its representatives and employees during the Event. The Sponsor agrees that it will not hold the County liable for any damage, loss, or injury caused by the actions of the Sponsor or its representatives.

    Force Majeure: Neither party shall be held liable for any delay or failure to perform their obligations under this Agreement due to causes beyond their reasonable control, including but not limited to inclement weather, natural disasters, acts of war, or government restrictions.

23. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
25. Electronic Signature
27. Date*
29. Sponsorship Payment

    Sponsorship payments can be submitted by check made payable to Powhatan County and mailed to: Powhatan County: ATTN "Event Name" 3834 Old Buckingham Rd, Suite A, Powhatan, VA 23139 OR delivered to the County Administration Building Treasurers Office  in person during regular business hours, M-F 8:30am-5pm.

    Payment can also be made online with credit card by visiting: https://powhatanva.myrec.com/info/products/default.aspx?CategoryID=104

    Please note, credit card payments are subject to a 3% convenience fee. 

    Thank you for your support and making Powhatan a great place to live and play!

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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

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