SIOA 2018 Exhibitor Registration Form

For the 40th year, the Summer Institute on Aging will support the professional development in aging for those persons working in the areas of health care, social service and education. Attendees are from all over the state of West Virginia. The dates of this year’s conference are June 12 - 14, 2018 at Lakeview Resort & Conference Center in Morgantown, WV.

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Memo Sent?
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Name * First Last
Name of agency/business/organization *
Address (Street or PO Box) *
Address 2
City *
State *
Zip Code *
Work Phone - ### - ### ####
Fax - ### - ### ####
Email *
Number of persons attending exhibit *
Name 2 First Last
Name 3 First Last
Name 4 First Last
Number of tables/spaces requested *

Tables/spaces are 6ft. in length
Do you need access to electricity? *
Yes No
Payment Method *

If you wish to pay by credit card, you can pay online by visiting https://goo.gl/3IoTch
Notes
Payment Amount