Senator Stefano's Somerset Senior Expo Registration Form

Organization Name (For Program Booklet)*

Exhibitor's Name*

Organization Mailing Address (For Program Booklet)*

Street Address Address Line 2 City State ZIP Code

Phone (For Program Booklet)*

Email (Used for Confirmation)*

Enter Email Confirm Email

Please add a short description of your organization for Senior Expo program booklet.*

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

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.

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

Check One - I/We will require an electrical outlet.*

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

I/We will be providing a healthcare screening.

If Yes, describe health screening.

Phone

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