AUTUMN SENIOR EXPO VENDOR/SPONSOR REGISTRATION FORM

Aging resources for individuals & caregivers residing in or relocating to Southern Illinois.

Registration Form

Vendor & Sponsor Table Reservation Information

Each table registration will include:

(1) 6 ft. table and (2) chairs
(2) lunches

If you require additional chairs or electricity, please call (618) 658-2775, to confirm availability as tables will be assigned on a first come, first served basis.

Please complete and submit the form below to register. I am participating as a (check one):(Required)

Vendor Only

Sponsor Only

Vendor & Sponsor

Vendor or Sponsor Name(Required)

First Last

Name to be advertised, if different from above

Website:

Facebook Page:

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Enter Email Confirm Email

Contact Name (if different from above)

All vendors and sponsors are responsible for providing a DOOR PRIZE valued at $25. Please provide a brief description of your organization, or information to be shared when raffling off your door prize:(Required)

VENDOR & SPONSOR TABLE RESERVATION — Includes (2) lunches per registration.

I would like to purchase a VENDOR TABLE RESERVATION at $25.00 each. Please indicate the number below:

Price: $25.00

I would like to purchase a SPONSOR TABLE RESERVATION at $250.00 each. Please indicate the number below:

Price: $250.00

I would like to purchase a SPONSOR RESERVATION (NO TABLE) at $225.00 each. Please indicate the number below:

Price: $225.00

I would like to purchase additional lunches at $5.00 per lunch. Please indicate the number of additional lunches you wish to purchase in the box below:

Price: $5.00

TOTAL AMOUNT TO BE CHARGED:

Comments

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