EOEEA-AGR

Pursuant to M.G.L. c. 138, Section 15F

Attachments

In order for your application to be considered complete, you must include the following documents. Incomplete applications will not be accepted.

1. Applicant information

Name of Licensed Farm-Winery, Farm-Brewery, Pub-Brewery or Farm-Distillery(Required)

Farm-Winery Farm-Brewery, Pub-Brewery or Farm-Distillery License Number(Required)

State of Issue(Required)

Contact Person(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone Number(Required)

Email(Required)

Do you intend to sell, sample, or both? Check all that apply.(Required)

Sell

Sample

What kind of beverage will you sell?

Wine

Beer

Cider

Mead

Distilled Spirit

Do you include ingredients in your Craft Beverage grown on your farm?(Required)

Yes

No

2. Event Information

Name of Agricultural Event(Required)

Type of Event(Required)

Agricultural Fair (as defined by MDAR policy)

Farmers Market (as defined by MDAR policy)

Other Agricultural Event

If you selected “Other Agricultural Event”, how does this event promote local agriculture?(Required)

Event Address(Required)

Street Address Address Line 2 City State ZIP Code

Event Phone Number(Required)

Event Website(Required)

3. Event Description

What are the date(s) and time(s) of the event?

Start Date(Required)

Month / Day / Year

MM

DD

YYYY

End Date(Required)

Month / Day / Year

MM

DD

YYYY

Start Time(Required)

Hours

:

Minutes

AM/PM

End Time(Required)

Hours

:

Minutes

AM/PM

If this is a weekly event, on what day of the week does the event occur?

If the event is an agricultural fair, does the event include competitive agriculture?(Required)

Yes

No

N/A

Is the event sponsored or run by an agricultural/horticultural society, grange, agricultural commission or association whose primary purpose is the promotion of agriculture and its allied industries?(Required)

Yes

No

If yes, identify:(Required)

4. Event Management

Name of Event Manager(Required)

First Last

Email Address(Required)

Phone Number(Required)

Is this person the on-site manager?(Required)

Yes

No

If no, identify on-site manager (include contact information):(Required)

If there are multiple managers, list them and include contact information:

Approval letter from event management including the name of the licensed farm-winery and the day(s), month and year of event. See Template 2.(Required)

Drop files here or

Max. file size: 50 MB.

Attach on-site manager(s) resume(s) or list any credentials or training of the on-site manager(s):(Required)

Drop files here or

Max. file size: 50 MB.

List of vendors with brief descriptions of products for current year/season(Required)

Drop files here or

Max. file size: 50 MB.

General

Attach a plan depicting the premises and the specific location where the license will be exercised.(Required)

Drop files here or

Max. file size: 50 MB.

Event operational guidelines or rules for current year/season(Required)

Drop files here or

Max. file size: 50 MB.

Consent(Required)

I do hereby attest that this information is true, accurate and complete to the best of my knowledge and I understand that any falsification, omission, or concealment of material fact may subject me to administrative, civil, or criminal liability.

Please type your name(Required)

Date(Required)

Name(Required)

First Last

Title(Required)

Farm-Winery, Farm-Brewery, Pub-Brewery or Farm-Distillery License Number(Required)

State(Required)