Online Vendor Registration

This form is for vendors registering for the 2010 LSIN Senior Expo.

Please complete the form below. After you submit the form, you will be taken to a payment page where you can make payment via Paypal (preferred) or find information to mail your payment.

Questions? Contact Mary Ellen Knecht.

The information you fill in will be emailed to us and you will receive a copy.

Agency/Business Name:

Name as it should appear in the program if different from above (Exhibitor Name may appear on Senior Expo promotional material)

Exhibitor Name:

Contact Person:

Mailing Address:

City:

State:

Zip:

Phone:

Mobile/Cell Phone:

E-Mail:

Will you provide a door prize?

Yes
No

Each exhibitor will be provided with 1 covered table (estimated 30” x 72”) and 1 chair.

Do you need access to an electrical outlet? ($25 fee)

Yes
No

Special considerations (including accessibility requirements)?

I understand that set-up time is from 2:00 - 3:00 p.m. and I agree to keep my exhibit open and staffed from 3:00 p.m. until 6:30 p.m.

Space will be assigned upon receipt of completed registration form and full payment.

Fees:
Commercial exhibitor before March 26: $175 (non-refundable)
Non-Profit – budget over $200,000: $75 (non-refundable)
Non-Profit - budget under $200,000: $ 25 (non-refundable)
Governmental agency: no charge
Electricity Charge: $25 (non-refundable)
Late fee for all exhibitors after March 26: $ 25 (non-refundable)

Payment Type:

Online via Paypal
I will mail a check

Comments:

Office Use Only: Please leave empty.

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