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OPEN CLASS POULTRY ENTRY Office Use Only
THE MONTGOMERY COUNTY AGRICULTURAL FAIR
16 CHESTNUT STREET, GAITHERSBURG, MD 20877 Received: _______________

Name: _______________________________________________ Exhibitor #: _____________________ Tally: ___________________

Address: ___________________________________________________________________________ Letter: __________________

City: _____________________________________ State: _____________ Zipcode: _______________ Comp.:__________________

Farm Name: _______________________________________ Phone: ___________________________
Passes: __________________
E-mail: _____________________________________________________________________________
Absolutely NO entries
I have read, understand and agree to abide by all the rules and regulations published in the Montgom-
ery County Agricultural Fair Premium Catalog. I also agree that I will not hold the Montgomery County will be accepted after
Agricultural Fair liable for any accidents or injury, which may occur while participating in the Fair. July 20, 2018.
I have read the rules and expectations for participation in the MCAC Fair and promise to support and Use certified mail and
practice humane treatment of animals at all times. print a receipt if using
I agree to present an MDA self-certification of animal health form to the department superintendent online entry.
prior to unloading animals.

Exhibitor’s Signature: _____________________________________________ Date: _______________ Premise ID# ____________________
Pullorum Test Results ____________
Parent/Guardian Signature: ________________________________________ Date:_______________
Avian Influenza Test Results _______
NOTE: USE ONE ENTRY FORM PER EXHIBITOR, ONE LINE FOR EACH ANIMAL, AND ONE LINE PER Permit to Sell ID# _______________
CLASS. SPECIAL ARRANGEMENTS CAN BE MADE WITH THE SUPERINTENDENT TO COOP YOUR (if planning to sell)
BIRDS!

ALL ENTRIES ARE FOR DEPARTMENT F ONLY—one form per exhibitor

Division Class Breed Cock Hen Cockerel Pullet

4-H Family Discount Pass (includes parking): Rates/Prices Subject to Change—$10/day; $50/season
mcagfair.com
ENTRY DEADLINE IS JULY 20th