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2018 Senior Health and Wellness Fair
Vendor Registration Form

Updated September 14, 2018

JUMP TO: Vendor Registration Form

This registration form is due no later than Friday, September 21, 2018. Vendors may also fill out a paper copy of the vendor form in person at the Cerritos Senior Center.

Space is limited, so please complete and submit this form as soon as possible. Applicants will be evaluated on a first-come, first-served basis and spaces will be assigned as applications are approved. In order to achieve a balance in the types of vendors represented at the Fair, the Cerritos Senior Center reserves the right to limit duplication of service providers. Event participation approval will be sent by e-mail no later than Monday, September 24, 2018. If you do not receive a notification about event participation by this date, please contact Melissa Pizano at (562) 916-8550.

If approved, appropriate fees are due to the Cerritos Senior Center by Friday, September 28, 2018. Fees are non-refundable and checks should be made payable to the City of Cerritos.

For additional information, visit the Senior Health and Wellness Fair Registration page, or call the Cerritos Senior Center at (562) 916-8550.

Vendor Registration Form

VENDOR CONTACT INFO

* Required: Please enter your vendor name below.

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* Required: Please enter your contact name below.

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* Required: Please enter your vendor address below.

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* Required: Please enter your vendor address city below.

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* Required: Please enter your vendor address state below.

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* Required: Please enter your vendor address zip code below.

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* Required: Please enter your e-mail below.

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* Required: Please enter your daytime phone number below.

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* Required: Please enter your fax number below.

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VENDOR DETAILS

* Required: Please select a type of agency below.

* Required: Please enter "Screening Type" below.

For-Profit
      $100 Non-refundable fee

For-Profit (Free Screening)
     No fee if a free screening is provided and
      approved by the City

     Screening Type:
      invalid entry ok required

Non-Profit
      No fee. Staff will contact you to request
      proof of Non-Profit status

Local/Federal/State/County
     No fee
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* Required: Please describe the nature of your business or organization below.


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* Required: Please describe the promtional materials to be provided below.


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* Required: Please select "Yes" or "No" to the question below.

* Required: Please enter purpose of outlet below.

Yes
     Purpose (if yes):
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No
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