SENIOR FAIR VENDOR REGISTRATION

Welcome! Thank you for your interest in registering to be a vendor at the Carbondale Senior Fair hosted by State Representative Paul Jacobs and State Senator Dale Fowler.

SENIOR FAIR EVENT DETAILS
Wednesday, September 24, 2025
9:00AM – 11:00AM

Carbondale Civic Center
200 S Illinois Ave.
Carbondale, Illinois 62901

Please complete and submit the form below to register as a vendor for the Senior Fair:

Vendor Name(Required)

First Last

Organization(Required)

Email(Required)

Enter Email Confirm Email

Phone(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Will you be providing health screenings?(Required)

What type of screening will you be providing?(Required)

Do you need electricity for your booth?(Required)

Will you be providing a door prize?(Required)

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