Senator Martin Senior Expo Registration Form Friday, October 13, 2023 | 10 a.m. – Noon St. John’s Center Church 432 Reading Road East Earl, PA 17519 Registration Deadline – Monday, September 11, 2023 Senior Expo Exhibitor Registration Form Organization Name (For Program Booklet)* Exhibitor's Name* Organization Mailing Address (For Program Booklet)* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest 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.*I am willing to share a table with another organization.* Yes No Please pair my organization with: 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. EmailThis field is for validation purposes and should be left unchanged.