Please Read the Instructions in the Entry Guidelines before completing this form.
Heart of the Valley will not be responsible for incomplete or improperly filled out forms.

Please print and fill out one copy of this Section (this page) PER ENTRANT

Please also fill out one copy of SECTION B: Entry Information PER ENTRY

Section A: Brewers' Information

1. Name_______________________________________________________________

2. Additional Brewer(s) _______________________________________________

3. Address ________________________________________________________

4. City ____________________ State/Province ______ Zip/Postal Code ________

5. Country ______________ Phone (H) (___)__________ (W) (___)___________

6. E-mail_________________________________________

7. Are you a first time brewer? ___ Yes ___ No

8. Are you a member of a Homebrew Club? ___ Yes ___ No
If "yes," what is the name? (Please spell out full name. Do not abbreviate.)

__________________________________________________________________

9. Entry Fees Enclosed:
 
I have entered _______ entries x $6 per entry = $________total

Please enclose a check for the total amount payable to Heart of the Valley Homebrewers

For Homebrew Competition only, please continue to SECTION B: Entry Information
For Home-made Soda and Homebrew Label entries this is the only page required for each entry.