Senior Expo Registration Tuesday, July 18, 2023 | 9:00 a.m. – 1:00 p.m. Pocono Mountain Swiftwater Elementary Center 135 Academic Drive Swiftwater, PA 18370 Senior Expo Exhibitor Registration Form Organization Name (For Program Booklet)(Required) Exhibitor's Name(Required) Organization Mailing Address (For Program Booklet)(Required) 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)(Required)Email (Used for Confirmation)(Required) Enter Email Confirm Email Please add a short description of your organization for Senior Expo program booklet.(Required)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.(Required) Yes No Check One - I/We will require an electrical outlet.(Required) Yes No Check One - This organization is a non-profit (501c3) or governmental agency(Required) Yes No I/We will be providing a healthcare screening. Yes No If Yes, describe health screening. CommentsThis field is for validation purposes and should be left unchanged.