The 10th Annual Chef One Dumpling Eating Contest Registration Form

Last Name: First Name: Nickname: Gender: Date of Birth: Address: City, Zip Code: Phone: Email: Competitive Eater: T-Shirt Size: Payment Method: Yes / No XS / S / M / L / XL/ 2XL / 3XL / 4XL / 5XL Credit Card / Check

Location: Sara D. Roosevelt Park (E. Houston St. btw Forsyth and Chrystie St.) New York City, NY 10079 Lower East Side, Manhattan Date & Time: Saturday, 9/28/2013, 1:00PM Prize: 1st Place: $2,000 2nd Place: $1,000 3rd Place: $500 Registration Fee: $20.00 (All proceeds will benefit the Food Bank for NYC) Registration Deadline: 9/06/2012 Eligibility: Participants must be 18 years of age or older.

Please return the registration form to Dumpling@chefonecorp.com or fax it to 718-821-5052. Payment by credit card: Please call the number below with credit card information ready. Payment by check: Please make check payable to Chef One Corp and mail it to 7 Bushwick Place, Brooklyn, NY 11206. If you have any further questions, please feel free to contact us at: (718) 744-6999 or email us at Dumpling@chefonecorp.com