Senior Expo Registration - Senator Ward, J

Organization Name(Required)

(For Program Booklet)

Exhibitor's Name(Required)

Organization Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

(For Program Booklet)

Phone Number(Required)

(For Program Booklet)

Email (Used for Confirmation)(Required)

Enter Email Confirm Email

Please add a short description of your organization for inclusion within the Expo program.(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.

Will you require a tablecloth?(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

Access to electric is limited and is not guaranteed. You must provide your own extension cord if requesting electric.

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.

Email

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

Senior Citizen Exhibitor Registration Form

Exhibitor Space