1. AUTISM ACCEPTANCE WALK & RESOURCE FAIR
APRIL 16, 2016
12pm-4pm
EXHIBITOR APPLICATION- INFORMATION TABLE
Whittier High School, 12417 Philadelphia St, Whittier, CA 90601
Exhibitor Information Tables are assigned on a first-come/first-served basis. Please complete and return this
application by March 31st
.
Name/Organization:
Address:
City/State, Zip Code:
Telephone #: FAX #:
Contact Person: Tel: #:
Business E-Mail Address:
Brief Description of Organization:
SPACE IS LIMITED - YOU WILL BE NOTIFIED IF YOUR APPLICATION IS ACCEPTED
Each exhibitor is provided with a table & two chairs.
Exhibitor must supply their own canopy.
In order to reserve an Autism Service Provider
exhibitor table, we are asking for a donation of
$100. Please make check payable to Autism Society
GLB/SGV/OC. Mail application and donation to:
Autism Society GLB/SGV/OC’s Empowerment Center
8635 Greenleaf Ave., Unit B
Whittier, CA 90602
DONATIONS— Autism Society GLB/SGV/OC is a volunteer run 501 c3 organization, established in 1971. Due
to the generous support from the community we are able to continue to provide free events and services. If you
are able to assist us with a donation for the Autism Acceptance Walk and Resource Fair, please check one of the
boxes below. All sponsors will be recognized in the event program and on social media. Craft Booth
Sponsors will also have their logo displayed at their sponsored booth.
Donate: Sponsor:
( ) Craft Booth Sponsor- $200 / 2 needed
Monetary $_______________ ( ) Bottled Water- $150 / 2 needed
( ) Sensory Bin- $75 / 4 needed
( ) Opportunity Drawing Item

2. Autism Society Greater Long Beach/San Gabriel Valley/Orange County &
Whittier High School
HOLD HARMLESS/INDEMNIFICATION AGREEMENT
The undersigned table applicant agrees to and shall indemnify, defend and hold harmless Autism
Society Greater Long Beach/San Gabriel Valley/Orange County & Whittier High School, its
agents, officers, elected and appointed officials, employees and volunteers against any legal
proceeding in law or equity, and further shall indemnify, defend, and hold harmless Autism
Society Greater Long Beach/San Gabriel Valley/Orange County & Whittier High School, its
agents, officers, elected and appointed officials, employees and volunteers from and against any
and all claims, liabilities, demands, suits, judgments, expenses, costs, and other legal expenses of
every kind to which Autism Society Greater Long Beach/San Gabriel Valley/Orange County
& Whittier High School may be subject by reason of any act or omission, whether intentional or
negligent, or from strict liability, arising from the conduct of any participant, invitee, attendee,
sponsor or any third person who is or is not an invitee, attendee, participant, or sponsor of the
event.
Event: Autism Acceptance Walk & Resource Fair
Date (s) of Event: Saturday, April 16, 2016
Agency:
Name/Title (please print) Signature Date
Name/Title (Please print Signature Date
Name/Title (Please print) Signature Date
For questions contact: Regina Moreno at 562-237-1520 or regina@greaterlongbeach-asa.org.