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Empowerment Fair Vendor Registration
Name
(Required)
First
Last
Organization
(Required)
Email
(Required)
Services Offered
(Required)
Website
(Required)
Organizational Phone
(Required)
How many tables will you need?
(Required)
How many chairs will you need?
(Required)
Do you need access to an electrical outlet?
(Required)
Yes
No
Consent
(Required)
I agree to the confidentiality policy.
Confidentiality
As a participant in the 2025 Empowerment Fair, I understand that I may have access to sensitive information, including names and identifying information, address/location, personal financial information, and health information. I agree to maintain the security and confidentiality of survey participants and related information. I will not disclose, share, publish, copy or distribute any survey information without express permission.
Would you like to purchase lunch?
(Required)
Yes
No
Each lunch is $15. Lunches consist of sandwich, chips, cookie, soda/water.
Lunch
Quantity
Price:
$15.00
Quantity
Payment Method
PayPal Checkout
Credit Card
MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number
Expiration Date
Security Code
Cardholder Name
