Senior Fair Vendor Registration

Please complete and submit the form below to register as a vendor for Representatives Halbrook, Wilhour, and Niemerg’s upcoming Senior Fair taking place on Tuesday, June 17, 2025 from 9 a.m. to 11 a.m. at the National Guard Armory, 1206 W. Temple Avenue, Effingham, IL 62401.

Space is limited and will be filled on a first come, first served basis.

With questions, please call Rusty Corneils at (630) 779-4565.

Senior Fair Vendor Registration

Vendor Name(Required)

First Last

Organization

Email(Required)

Enter Email Confirm Email

Phone(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Do you need electricity for your booth?(Required)

Will you be providing health screenings?(Required)

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

Will you be bringing a door prize?(Required)

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