APPLICATION
April 30 & May 1, 2005

Name (print)
Business Name
Address
City
Bus. Phone ( )
N.Y. State sales tax #
Fine Arts/Crafts desc.
Slide descriptions:
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____________________________State_____Zip__________
____________________Home Phone ( )__________________
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GENERAL RELEASE

I agree to indemnify and hold harmless The Lloyd Harbor Historical Society (“Society”), and the State of New York, the Office of Parks, Recreation and Historic Preservation and the Long Island Region (“Parks”) from and against any and all claims, suits, losses, damages or injuries to persons or property arising out of or in connection with the use of the Marshall Field Farm Complex and Caumsett Historic State Park. Further, I will not hold the Society, or the Parks liable for failure to perform or fulfill their contractual obligations provided such failure is caused, occasioned or impeded by closures of site location due to any causes beyond their control. Insurance for such loss, damages or injury will be my sole responsibility.


Signature_____________________________________________Date___________

Sincerely,

Joanne Rossetti Hahn, Cindy Morrongiello and Richard Thatcher
Daffodil Hill Fine Arts & Crafts Committee
Lloyd Harbor Historical Society