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IAMSE Restaurant Registration
After completing this form, please send an invoice for IAMSE, 1000 5th Ave. Suite 100, Huntington, WV 25701 to
lynne16@vt.edu
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* Indicates required question
Restaurant Name
*
Your answer
Owner Name
*
Your answer
Owner Email
*
Your answer
Owner Phone
*
Your answer
Manager Name
*
Your answer
Manager Email
*
Your answer
Manager Phone
*
Your answer
Signature Tasting
Describe the type of “signature tasting” you plan to serve. Please be as specific as possible, including the size of the portion
Your answer
Presentation Needs
Describe any special plating or presentation needs: (example, dishes, utensils etc.)
Your answer
Electrical Needs
Describe any electrical needs you have for this event
Your answer
VDH Temporary Food Event Permit
*
Has your restaurant already paid for a 2019 VDH Temporary Food Event Permit? If so, please email an updated permit and copy of receipt to
lynne16@vt.edu
Yes
No
Responsible party for securing VDH permit
If your restaurant has not yet paid for a Temporary Food Event Permit in 2019, who from your restaurant will be responsible for securing the permit by May 6th, 2019 (Download a permit application at
https://medicine.vtc.vt.edu/content/dam/medicine_vtc_vt_edu/community/temporary-food-establishment-vendor-application.pdf
)
Your answer
Other comments / questions
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