Registration Form

Come Celebrate with Us on 36 Years of the Passing of the American's with Disabilities Act

You will enjoy multiple community vendors, refreshments, panel discussions and the film "Back on Track."
Reynolda Manor Branch Library

1:00pm - 4:00pm - 2839 Fairlawn Drive NW, Winston-Salem, NC 27106
Registration Form

Attendees & Vendors
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
How Many Guests Will Attend with Applicant?
VENDOR REGISTRATION FORM AND FEES
Vendors must register and pay their fees below. If you're a non-profit, you still must fill out all contact information but do not select the option to pay the $25 fee.
Name of Vendor

Organization NameOwner/Vendor Attendee
Phone Number
Organization Contact Number if not the same as above.Format: (000) 000-0000.
Vendor Fee
prevnext( X )
Vendor Fee
Unless a non-profit, all vendors must pay a non-refundable deposit fee. Payment at bottom of form.

$25.00 How Many will Attend with Vendor
Item subtotal:$0.00

Total

$0.00
Just Want to Donate?

Paypal: @WSMCPD OR CashApp: $WSMCPD

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Just Want to Donate?