Senior Citizens Expo Exhibitor Registration Form

Thank you for your participation in any or all of our upcoming Senior Citizens Expos. Your attendance is vital to the success of these events! Registration deadline is Monday, July 3.

For questions or additional information, please contact Rhonda Race at the Bradford office at 814-362-4400 or by email at rrace@pahousegop.com.

Organization Name *

Mailing Address *

City *

Zip Code *

Phone *

Website Address

Email Address *

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Please select the expo or expos which you plan to attend: *

Bradford: Friday, Aug. 4
Kane: Friday, Sept. 8
Roulette: Friday, Oct. 13

Please check all the appropriate boxes that pertain to your organization.

I will bring a door prize.
I will need an electrical outlet and I will bring my own extension cord.
Please contact me about sponsoring these expos with a donation.
My organization will host a health screening.

If hosting a health screening, describe screening type

First Name *

Last Name *

Phone *

Email Address *

Leaving this box checked verifies that you would like to receive legislative email updates.