Senior Connection
PO Box 11929
Prescott AZ 86304
(928) 778-3747

Secure Expo Registration Form

TABLES (All tables are 6' long):
Electricity (Limited number of booths):

Payment Options

If you want to pay through Paypal:
(We will send you a Paypal Invoice shortly)

Annual Membership Fee: $375, includes Booth at
Fall Senior Connection Seniors & Caregivers Conference & Expo
and other GREAT Services!

Be sure to print a copy of this form for your records before submitting.
Thank You!