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2020 Senior Info/Expo Exhibitor Application

Please correct the field(s) marked in red below:

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Area / Table #:

 

Total Paid:

 

Cash or Check #:

 

Date Received:

 

 


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EXHIBITOR APPLICATION

City of Maricopa Age-Friendly Special Event – Limited to information & materials distribution. No sales allowed.

Date:  Saturday, January 25, 2020           Site:    Copper Sky, 44345 W. Martin Luther King Jr. Blvd.

Application Deadline: Wednesday, January 10, 2020 by 6 pm. Please provide all information requested. Applications received after the deadline will be charged a late fee of $15.00.

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Co./Org Name (to be used for sign):
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Contact Name and Title: 
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Mailing Address:
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Zip Code:
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Email Address:
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Type:
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Type:
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Which one of the following best describes the products and/or services provided? (Check all that apply)
Which one of the following best describes the products and/or services provided? (Check all that apply)
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Electricity Needed? (Please bring your own extension cords)
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Electricity Needed? (Please bring your own extension cords)
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EIN #:
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EXHIBITOR WAIVER

I am the authorized agent for the organization / business listed above, agree to hold the City of Maricopa harmless for theft of, damage to, loss or destruction of materials or property which I may have on the grounds of a City of Maricopa special event. All requests are subject to approval and acceptance by the City of Maricopa Senior Info/Expo Event Committee and their decision is final. I understand that my signature holds me responsible for the information included in this request. Any cancellation of the event, after January 10, 2020, or fees paid will not be refunded and no negotiations will be made outside of this agreement. I further understand that once signed, this is a binding agreement.

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Electronic Signature 
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Date Signed: 

Payment due with application. CASH OR CHECK ONLY

Make check PAYABLE TO: CITY OF MARICOPA

MAIL APPLICATION & PAYMENT TO:

Senior Info/Expo

Maricopa City Hall

39700 W. Civic Center Plaza

Maricopa, AZ 85138

Questions? CONTACT:

Brandelyn Hughes,

Coordinator Age-Friendly Committee

Senior Info/Expo Special Event

Brandelyn.hughes@maricopa-az.gov

(520) 316-6842