vendor registration form for senior resource fair br rehab

The Senior Resource Guideinvites you to participate in a

SENIOR RESOURCE FAIR forSOCIAL WORKERS, CASE MANAGERS, &

DISCHARGE PLANNERSWednesday, April 17, 2013

Baton Rouge Rehab Hospital8595 United Plaza Boulevard

Baton Rouge, LA 708095:00pm - 7:00pm (set-up at

4:30pm)REGISTRATION FORM FOR VENDORS (Includes an Entry Fee of $50.00)

Today’s Date:       Contact Person:      

Company Name:      

Company Address:      

City:       State:       Zip:      

Business Phone:       Cell:       Fax:      

Email Address (required):      

Please bring the following:1. A Door Prize (Valued at $25.00 or more) 2. Food or Beverage - must be commercially prepared Plates/Napkins/Utensils will be provided.

Small Tray of Finger Sandwiches Cheese & Crackers Veggies & Dip Chicken Wings/Tenders with Sauce Mixed Salad (Green/Pasta/Potato) Fresh Fruit Tray 6-pack of Iced Soda, Juice, Tea, Lemonade or Water Dessert Other:      

3. Educational Materials for Attendees: Handouts on specific illnesses/treatments, brochures, etc.4. 2’x4’ Table/Card Table and Tablecloth: Chairs provided. Few tables are available. Let us know if you absolutely need one.

Complete this Registration Form, make a copy for yourself, then mail it along with the $50.00 Entry Fee to: Senior Resource Guide of LA, LLC, 1412 Sigur Avenue, Metairie, LA 70005

This event has been approved by N.A.S.W. to provide 1.5 CEUs to

Social WorkersThe goal of the resource fair is to offer the

attendees the most up-to-date, state-of-the-art information in your field. Plan on providing

educational data and feel free to include something unique about your services to the

elderly along with general information.

(Make checks payable to the Senior Resource Guide of LA, LLC)We will confirm receipt of your Registration Form and Entry Fee by phone and/or email.