Senior Expo Registration - Senator Ward, J

Organization Name (For Program Booklet)(Required)

Exhibitor's Name(Required)

Organization Mailing Address (For Program Booklet)(Required)

Street Address Address Line 2 City State ZIP Code

Phone Number (For Program Booklet)(Required)

Email (Used for Confirmation)(Required)

Enter Email Confirm Email

Please add a short description of your organization for Senior Expo Program Booklet(Required)

Exhibitor Space

The information below will help us determine your needs for your space.

If you require more than the one chair that is provided, how many TOTAL chairs do you need?(Required)

Please tell us how many chairs you need for your exhibit, 1 is provided, if you need 4, please tell us 4.

Please tell us if you need a tablecloth for your exhibit(Required)

Yes
No

Check One - My exhibit, when placed upon a table, is higher than 3 feet.(Required)

Yes
No

Check One - I/We will require an electrical outlet.(Required)

Yes
No

Check One - This organization is a non-profit (501c3) or governmental agency(Required)

Yes
No

I/We will be providing a healthcare screening.(Required)

Yes
No

If Yes, describe health screening.

PLEASE CONFIRM THAT THE INFORMATION ABOVE IS CORRECT BEFORE YOU CLICK SUBMIT. YOUR EMAIL ADDRESS WILL RECEIVE A CONFIRMATION EMAIL. IF YOU DO NOT RECEIVE THE CONFIRMATION EMAIL, PLEASE CHECK YOUR SPAM FOLDER.

Phone

This field is for validation purposes and should be left unchanged.