Share the history of Lee’s Summit’s 150th Birthday by displaying your memories with photographs or artifacts at the Art and Artifacts Fair.

1. Art & Artifacts Fair/Historical Bike Ride
May 16, 2015
Help us celebrate May Preservation Month by participating in the Lee’s Summit Art and Artifacts Fair & Historically
ThemedBike Ride Saturday,May16, 2015, in the CityHall Lobby from11 a.m. - 2 p.m. The ¼ mile bike ride will beginon
the southside of City Hall on 3rd
St. at 1:45, and end at the new Lee’s Summit Historical Society Museum located at 220
SW Main St. The event is sponsored by the Lee’s Summit Historic Preservation Commission, in partnership with the
Lee’s Summit Historical Society.
 Share the historyof Lee’sSummit’s150th
Birthdaybydisplayingyourmemories withphotographsorartifacts. Items
will be ondisplayMay16 duringthe Art & Artifactsevent,heldinconjunction withthe City’sEquipmentShowand
openingof the Centennial Time Capsule!
 Bringyour itemswithacompletedentryformandwaiverformtoCity Hall duringthe businesshours8a.m. to 5 p.m.
weekdaysbyMay8, 2015. Itemsmaybe pickedupby appointment throughRonSeyl (816-969-1603). There isno
limitonthe numberof historicartifacts to submit.
 Or, pull outyourbike,includingthose vintage bikes! Kidsare encouragedtodecorate theirbikes. Adultsdressas
your favorite historical eraorcharacter and show it off as youride downtowntothe Lee’sSummitHistorical Society
Museumfrom1:45-2:00 p.m.
ARTIFACTS Entry Form
ARTIFACTNAME (Submitone formperitem):
AGE OF ARTIFACT(if known):
OWNER’SNAME and ADDRESS:
OWNER’SPHONE: OWNER’SEMAIL (if available):
DESCRIPTION OFARTIFACT:Includehistorical significance,personalsignificance,age,and how you obtained the item.
Attach additionalsheet(s) asnecessary. PHOTO ATTACHED Yes No
WILLING TO DONATETHIS ITEM TO HISTORICALMUSEUM? Yes No Maybe
Return Entry forms with waiver form for the Art & Artifacts by May 8, 2015 for consideration.
BIKE RIDE Entry Form
BIKE RIDER’SNAME (Submitone formperrider):
ADDRESS:
PHONE: EMAIL (if available):
Entry form with waiver form for the Bike Ride is due at the time of the event.
Pickup formsat CityHall or downloadatLSPlanning.net.
Date filed: Received by: Entry #

2. 2015 LEE’S SUMMIT ART AND ARTIFACTS FAIR
CONSENT TO PARTICIPATION, WAIVER AND RELEASE
I ___________________________ hereby consent to participation in the 2015 Lee’s Summit Art and Artifacts
Fair (hereinafter “the Fair”) hosted by the Lee’s Summit Historic Preservation Commission, in partnership with
the Lee’s Summit Historical Society. I certify that I am the rightful, legal owner of and am entering the
following art and artifacts item(s) in the Fair:
_______________________________________________________.
I understand that my entry of these items is voluntary. I further understand that by entering the above item(s)
in the Fair that I am assuming all responsibility and liability for loss, damage, or injury which may occur to said
item(s) or me as a result of participation in the Fair.
I understand that I may be asked to relinquish custody and control of said item(s) to a member or members of
the Lee’s Summit Historic Preservation Commission, the Lee’s Summit Historical Society or the City of Lee’s
Summit, and I hereby give my consent for said member or members to take custody and control of said
item(s) for the duration of the Fair, beginning at the submission of my application for participation. I
understand that I am responsible for retrieving said item(s) by 5:00pm, Monday, May 18th, 2015 at City Hall.
I hereby agree to release and hold harmless the Lee’s Summit Historic Preservation Commission, the Lee’s
Summit Historical Society, and the City of Lee’s Summit, as well as their officials, agents, employees,
predecessors, successors, supervisors, insurers, volunteers and subdivisions from any and all liability, actions,
claims, demands, or suits whatsoever, which I may now or hereafter have, on account of or arising out of any
damage to the aforementioned item(s), injuries, or damage to any right, including loss of time, services,
income or society during the course of my participation in the Fair, including any time when the
aforementioned item(s) may be in the custody or control of the Lee’s Summit Historic Preservation
Commission, the Lee’s Summit Historical Society, the City of Lee’s Summit and their members.
My consent to participation in the Fair as well as the promises contained herein are voluntary and made of my
own accord.
____________________________________
Participant Signature
___________________
Date
____________________________________
Printed Name