For-Profit Businesses Registration

Seniors Active Living Fair and Open House For-Profit registration

Organization Name(Required)

Contact Person Name(Required)

Contact Number(Required)

E-mail(Required)

Mailing address(Required)

Number of People attending(Required)

#1 Name of Person attending(Required)

Contact Number(Required)

#2 Name of Person attending

Contact Number

Electric Outlet required(Required)

Tablecloth required(Required)

Will you provide Swag item for our information bags (branded merchandise ex. pens, magnets, and notepads to bags, brochure)(Required)

Would you like to donate a door prize(Required)

If Yes, please provide a description of the item(Required)

Photo Consent(Required)

On behalf of your organization, you consent to having your photo taken during the event

Open House registration

Price:

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Payment Method

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name