Senator Brooks’ Senior Expo Friday, September 23, 2022 10:30 a.m. – 1:00 p.m. Greenville Christian & Missionary Alliance Church 63 Conneaut Lake Road (across from the VFW) Greenville, PA Exhibitor Registration Form Senior Citizen Exhibitor Registration Form This information is for the Program BookletOrganization Name* Organization Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Please use the space below to indicate the information you would like to have included in this year’s exhibitor directory. Feel free to include your organization’s mission statement, available services, contact info, etc.*Exhibitor's Name* Email (Used for Confirmation)* Enter Email Confirm Email Exhibitor SpaceThe information below will help us determine your needs for your space.If you require more than the two CHAIRS that are provided, how many TOTAL chairs do you need?Please tell us how many chairs you need for your exhibit, 2 are provided, if you need 4, please tell us 4. If you require more than the one TABLE that is provided, how many TOTAL tables do you need?Please tell us how many tables you need for your exhibit, 1 is provided, if you need 2, please tell us 2. Check One - My exhibit, when placed upon a table, is higher than 3 feet.* Yes No Is your organization willing to share a table? Please provide the name of the organization you are willing to share a table. Check One - I/We will require an electrical outlet. (Limited availability)* Yes No My organization specializes in helping Veterans and their families. 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. NameThis field is for validation purposes and should be left unchanged.