Senator Stefano’s Fayette Senior Expo Registration Form Tuesday, September 27, 2022 10:00 a.m. to 12:00 p.m. Penn State Fayette, The Eberly Campus 2201 University Drive, Lemont Furnace, PA 15456 Senior Expo Exhibitor Registration Form - Fayette Organization Name (For Program Booklet)* Exhibitor's Name* Organization Mailing Address (For Program Booklet)* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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. Yes No Yes, for each table Check One - My exhibit, when placed upon a table, is higher than 3 feet.* Yes No Check One - I/We will require an electrical outlet.* Yes No Check One - This organization is a non-profit (501c3) or governmental agency* Yes No I/We will be providing a healthcare screening. Yes No If Yes, describe health screening. PhoneThis field is for validation purposes and should be left unchanged.