Kansas Department of Revenue
Alcoholic Beverage Control Division
915 S.W. Harrison Street
Topeka, KS 66625-3512
Phone: 785-296-7015 Fax: 785-296-7185
REQUEST TO PARTICIPATE IN SPECIAL EVENT BY
Kansas Farm Winery, Microbrewery or Microdistillery Licensees
Who is required to complete this form?
Licensed Kansas farm wineries, microbreweries or microdistilleries who wish to participate in a special event
monitored and regulated by the Alcoholic Beverage Control (ABC) and offer tastings of the wine, beer or spirits they
manufacture. Tasting events must be held in a location that liquor by the drink is authorized.
In addition to offering tastings at the special event, K.S.A. 41-308a also allows Kansas farm wineries to sell
unopened containers of wine manufactured by the farm winery if retail sales are authorized. The approved form
must be displayed at the event.
No special event can be held on a premise that possesses a private club liquor license or cereal malt beverage
license; or, in a location where liquor by the drink or retail sales are not authorized.
Instructions
Complete this form and return to the address or fax number above. Your request to participate must be received by
the Director at least ten (10) days prior to the event. Failure to submit this notification at least ten (10) days in
advance of the special event may subject the licensee to administrative
penalties.
SECTION 1 – LICENSEE INFORMATION
Farm Winery – Samples
Farm Winery – Sales (unopened containers of wine manufactured by the winery)
Request Type:
Microbrewery – Samples
Microdistillery – Samples
Licensee DBA Name
License Number
Requestor Name
Email Address
Business Phone Number
Cell Phone Number
SECTION 2 – SPECIAL EVENT INFORMATION
Title of Event:
Sponsor of Event:
Event Contact Name
Cell Phone Number
Event Location Address
City
County
Zip Code
Date of Event
From Time
AM
To Time
AM
PM
PM
Is there a liquor license or Cereal Malt Beverage License at this location?
Yes
No
If yes, is the location licensed as a Class A or Class B Club?
Yes
No
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