Event Registration Form
Last Registration Day - May 31, 2024
Event Information
State's Attorney Jim Rowe's Annual Senior Safety Fair
Vendor Information
Please fill name and contact information
Location: Quality Inn & Suites
800 N. Kinzie Ave. Bradley, IL 60915
Vendor Check in and set up at 8AM
A Vendor table will be provided
event starts at 9AM and ends at 1PM
Your Name
*
Mr.
Mrs.
Miss.
Prefix
First Name
Last Name
Company Name
*
Email Address
*
example@example.com
Contact Number
*
Please enter a valid phone number.
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Would you like to be updated about the upcoming events?
Yes
No
Will you provide a Raffle item vauled at $20 or more to be raffled off at the event Please bring item with you to event and have your name of business card attached to the item.
*
Yes
No
Do you require any Accommodations for your table?
Please verify that you are human.
*
Sign: I commit to being at this event as a vendor
*
Submit
Should be Empty: