Name *

First Name

Last Name

Liability Waiver *

I have read and agree to all Terms and Conditions listed on the website.

I agree

Name *

First Name

Last Name

Date *

MM

DD

YYYY

Time *

Hour

Minute

Second

AM PM

Address *

Address 1

Address 2

City

State/Province

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Liability Waiver *

I have read and agree to all Terms and Conditions listed on the website.

I agree

Required approval *

I understand that this event proposal will need to be approved by the WVM Board Of Directors in order to be added to the membership events calendars. If approved and then later I am unable to host this event, I will notify the Board Of Directors with reasonable notice so that calendars may be updated prior to the event date.

Name *

First Name

Last Name

Scheduled Potluck Date *

MM

DD

YYYY

Safe Food Handling - Foods that need cooking *

I understand that if I am transporting non-dried food or goods (dried goods are bread, chips, crackers, candys) that must be cooked, I will maintain safe temperatures of 40F or below via an ice filled cooler. I will keep my hands clean before handling food.

I agree

Safe Food Handling - Cooked Foods *

I understand that if I am transporting hot or cooked food or goods (such as meats, seafood, items containing dairy), I will maintain safe temperatures of 140F or above OR ensure that my perishables are consumed within 1 hour after they cook. I will keep my hands clean before handling food.

I agree