Cincinnati Beer Week 2017 Registration Name * This name will be public. Street Address * City * Neighborhood (i.e Hyde Park, Covington, Mason) State * Ohio Kentucky Zip Code * Phone * This is the phone number you don't mind the general public calling. Email * First Name * Last Name * Username * You will need your username and password to log in to the site to let us know about your Cincinnati Beer Week event(s). Upon submission of this form, you will receive an email with your username, password, and the url of the login page. Password * DIRECTIONS: Please choose the FIRST option, starting from the top, that is true about your organization. * Do you serve beer to be consumed on-site (i.e. bar, restaurant, brewery WITH taproom, etc)? ($150 registration fee) Do you ONLY sell beer for carry out (i.e. retail store, drive thru, etc)? ($50 registration fee) Are you a wholesaler (i.e. distributor)? ($300 registration fee) Are you a non-permit holder that CANNOT sell beer directly to the public (i.e. brewery WITHOUT taproom, beer blogger, homebrew store, homebrew club, etc)? ($10 registration fee) Are you an Ohio Self Distributing Brewery? Yes No Upload Your Logo (please check that the image's dimensions are around 1400 x 1400 pixels or less. If your logo exceeds this size, please email to email@example.com. Thank you!) Uploading Files. Please Wait. Drop a file here or click to upload Choose File Maximum upload size: 2.1MB Accepted file formats: jpeg, gif, png, bmp Website http:// Your venue's public website Facebook http://www.facebook.com/ 1.3 billion of your closest friends. Twitter @ Tweet if you got it. Google Page YouTube Page To be included on Untappd check-ins, included your FourSquare url here: Many Hands Make Light Work (Pilsner) Breweries: Blank Slate (host) / Christian Moerlein / Listermann / Municipal / Narrow Path 1/6 Barrel - OH ($73 each) KY ($75) * 1/2 Barrel - OH ($165) KY ($170) * Cans - OH ($31.98 / case) KY ($33.30 / case) * Get Wit It (Belgian Wit) Breweries: Wooden Cask (host) / Bad Tom Smith / Cellar Dweller / Nine Giant / Old Firehouse 1/6 Barrel - OH (?) KY ($85.99) * 1/2 Barrel - OH (?) KY ($174.44) * Cumulus (Kellerbier) Breweries: Rhinegeist (host) / 50 West / Mash Cult / Paradise / Woodburn 1/6 Barrel - OH ($105) KY ($85) * 1/2 Barrel - OH ($185) KY ($175) * Muddle Lover (Mojito Inspired Wheat Ale) Breweries: MadTree (host) / Darkness / Rock Bottom / Taft's / Tap & Screw 1/6 Barrel - OH ($69.99) KY ($74.99) * 1/2 Barrel - OH ($159.99) KY ($169) * Bloom (Hibiscus Gose) Breweries: Braxton (host) / Fibonacci / Hofbrauhaus / Queen City / Rivertown 1/6 Barrel - OH ($93) KY ($105) * 1/2 Barrel - OH ($193) KY ($210) * Obey (Tart Raddler) Breweries: Mt Carmel (host) / Dogberry / Streetside / Urban Artifact 1/6 Barrel - OH (?) KY (?) * 1/2 Barrel - OH (?) KY (?) * Collaboration Beer Delivery Options Requested Beer Delivery Day of the Week Beer Buyer Contact Name Glasses and Flags Each registered venue will receive a case (12) of glassware and a flag. Additional cases of glassware or banners can be purchased below and MUST be paid for in advance of the cutoff date. If Cincinnati Beer Week does not receive payment before the noted deadlines, we may be unable to fulfill additional orders for additional glassware and flags. ADDITIONAL case of 12 CBW 16 oz. Arc Oslo Pilsner glasses [$30.00] Click here to see a sample of the glassware ADDITIONAL Flag [$24.00] Total Payment (Registration Fee + Additional Glassware + Additional Flags) $ Note - You are only paying for your registration fee and additional glassware and flags. You will need to coordinate payment with the distributor for the collaboration beer(s) you are preordering.