Sidney-Shelby County YMCA

Organization Name:*

Contact Person:*

Address :*

Phone :*

Email :*

Do you wish to be included in the passport drawing? :*

Yes
No Thank You

Please select the items you will require:*

I will not need any of these items
Electricity (Available on a limited basis)
1 Table and 2 Chairs
Table Covering

# of 8' spaces ($20.00 each) :

What type of merchandise / service will you be promoting?

Will your display include any of the following?
Audio/Visual Equipment
Health Screen (please describe below)
Live Demonstrations (please describe below)
Premium Giveaways (please describe below)

Please Describe any Giveaways, Health Screens, or Demonstrations you will be doing:

Payment Method:
Mail Check to: Sidney-Shelby County YMCA, Attention Suann Kleinhans, 300 E. Parkwood Street, Sidney Ohio 45365 Please invoice me I will be calling with a credit card payment

Verification Code

HealthFair

Health Fair Registration Form