LifeStyle Transitions
"Serving The Needs Of Seniors And Their Children"
Senior Living Consultation and Services
Expo Booth Application

Application for Booth Space at North Mississippi Senior Expo 2011

May 6, 2011 - 9am-2pm

By signing this form, you are agreeing to participate in the North Mississippi Senior Expo 2011.

Please complete, sign and mail this application along with your payment to:

                                                        LifeStyle Transitions

                                                         P.O. Box 4

                                                         Nesbit, MS 38651

                                                         Attention: Susan East

                                    Phone:  (901) 482-0018   Direct Fax: 901-435-0750

                                    Application Deadline is Wednesday March 30, 2011

 Business Name as it appearS in brochure: ____________________________________________________________________Business Name as it appears
on check:  ____________________________________________________

 Describe Your Business:  ____________________________________________________________________

 _____________________________________________________________________Print
Contact Person First Name: ___________________ Last Name: ________________

Street Address: _____________________________________________________________________

City, State, Zip Code: _________________________________________________________________

Phone Number: _________________         Fax Number:  ______________________

Email Address: ________________________________________________________________

Number of Electric outlets needed (applicant charge $20 each): _______________________

 Authorized Signature: _________________________Date: ______________
Please Indicate:

Non-Profit booth $150 – outlet extra $20 ________________

 Exhibitors booth $250   - outlet extra $20 _______________

                                    Expo Member                            Premium Member (Sponsor)

                                     $349 per year                                         $849 per year

                                 *includes Senior                                    * includes Senior

                                     Expo Booth                                            Expo Booth

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