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First Name:

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Last Name:

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Telephone:

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Cell Phone:

Email:

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Address:

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City:

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State:

Please Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *

Zip Code:

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Provide a detailed description of the products or services that you will offer:

Will you be selling any items?

Please Select One Yes No *

CA Sales Tax Permit No.:
Required if items are sold

City of Rancho Mirage Business License Number:
Required if items are sold

Select from the following list. Other options are available upon request:

10 x 10 canopy and back wall, with (1) 30” x 8’ table and (2) chairs (Price: $500.00)

10 x 20 canopy and back wall, with (4) 30” x 8’ table and (3) chairs (Price: $800.00)

Electrical Hook-Up ($100.00)

All applications are subject to approval. Once received and approved, payment and a signed contract will be required to reserve your space. If you have questions please call us, 760-766-1777 or email: info@DesertConcours.com.