First Name*

Last Name*

Title*

Business Name*

Email Address*

Phone Number*

Cell

Mailing Address*

City*

State (KS)*

Zip*

Social Media Handles/URLs for Advertising Purposes

Sponsorship level(s) I have chosen:* Sponsorship level(s) I have chosen:* Presenting Sponsor $10,000 Mainstage Sponsor $3,500 Military Appreciation Night at Rock River Rapids $3,500 People's Choice Sponsor $3,500 Kid's Corner Sponsor $3,500 KCBS BBQ Cook-Off Sponsor $2,500 SCA Sanctioned Steak Cook-Off Sponsor $2,500 Backyard BBQ Cook-Off Sponsor $2,500 BBQ Champion $700 BBQ Supporter $400

Payment Method* Payment Method* I will call Jenay with my credit card information I will mail a check to the City of Derby (instructions below) Please invoice me