Bucks County Senior Expo Exhibitor Registration Form Thursday, October 17, 2024 | 10 a.m. – 12 p.m. Upper Bucks County Technical School 3115 Ridge Rd. Perkasie, PA 18944 Registration deadline: Sept. 13 Organization Name(Required) (For Program Booklet)Name of Person Attending:(Required)Name Primary Contact Email (This email is used only to communicate with attending exhibitors and is not publicized.)(Required) Enter Email Confirm Email Organization Mailing Address (Please list as you wish to appear in program distributed to attendees)(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 Organization Phone (Please list as you wish to appear in program distributed to attendees)(Required)(For Program Booklet)Organization Description (Please provide a short description for inclusion within the program distributed to attendees.)(Required)Please limit responses to 350 characters or lessExhibitor SpaceThe information below will help us determine your needs for your space.If you require more than one chair that is provided, how many total chairs do you need?(Required) Please tell us how many chairs you need for your exhibit, 2 are provided, if you need 4, please tell us 4.Please tell us if you need a tablecloth for your exhibit(Required) Yes No 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. EmailThis field is for validation purposes and should be left unchanged.