Dominion Health and Wellness Expo

Health & Wellness Expo Vendor Registration

Wednesday November 3rd
6:00 PM to 8:00 PM

Vendor/Company Name*

Vendor Contact*

First Name

Last Name

Vendor Cell Phone (Primary Contact) *

Vendor Address*

Address Line 1

City

State

ZIP Code

Vendor Email*

The Vendor Registration Fee is $100.
You may also add electricity or an additional table for $25.00 each.

Add Electrical Hook Up at Table

If you would like electricity at your table please set the quantity to (1) one.

$ 25.00

Quantity:

Add Additional Table

If you would like an additional table please set the quantity to (1) one.

$ 25.00

Quantity:

Total To Be Charged $

Credit Card

Signature*

Hidden Calc Field