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2. Name of Individual/ Organization
4. Contact Person*
5. Phone Number*
7. Address
8. Email
10. City
11. State
12. Zip Code
14. Driver's Name
15. License Number
17. Insurance Card
18. Driver's License
20. Number of Participants
21. Type of Entry (Check all That Apply)

    1. Car
    2. Truck
    3. Float
    4. Bikes
    5. Marching Unit
    6. Other
23. Liability Disclaimer
    All entrants are responsible for having the appropriate liability insurance. The City of Moss Point or Recreation and Community Engagement Department will not assume the responsibility for damages to vehicles or injuries to individuals as a result of participating in the Christmas Parade. Participants in the parade should do so at their own risk.
25. Insurance Company
26. Policy Number
28. 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.
30. Electronic Signature
Leave This Blank:


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

    This field is not part of the form submission.

34. Submit Submit and Print

* indicates a required field