Senior Citizens Expo Exhibitor Registration Form

Thank you for your participation in our upcoming Senior Citizens Expo. Your attendance is vital to the success of this event!

For questions or additional information, please contact Rhonda Race at the Bradford office at 814-362-4400 or by email at rrace@pahousegop.com.

Organization Name

Mailing Address

City

Zip Code

Phone

Website Address

Email Address

__________________________________________________________________________________

Please select the expo or expos which you plan to attend:

Bradford: Friday, Aug. 1 Kane: Friday, Sept. 12 Roulette: Friday, Oct. 10

Please check all the appropriate boxes that pertain to your organization.

I will bring a door prize. I will need an electrical outlet and I will bring my own extension cord. Please contact me about sponsoring these expos with a donation. My organization will host a health screening.

If hosting a health screening, describe screening type

First Name

Last Name

Phone

Email Address

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