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Thursday, May 9, 20198:30 a.m. - 1:30 p.m.
Will Rogers - Amon G. Carter Jr. Exhibits Hall
3400 Burnet-Tandy Drive, Fort Worth, Texas 76107
Senior Synergy Expo is a health and lifestyle event for boomers, seniors and caregivers! Register by
completing this form or online at www.SeniorSynergyExpo.com.
Attendee Registration (Information collected will not be shared, distributed or used for any purpose other than Senior Synergy Expo)
Please Print Clearly
Name: _______________________________________________________________________________
Address: _____________________________________________________________________________
City/State/Zip: _________________________________________________________________________
Phone: ____________________________ Email: ____________________________________________
Circle your age: 18-24 25-34 35-44 45-54 55-64 65-74 75+
If applicable, what is the name of your group association? (e.g. church name, senior center name, YMCA, etc.)
________________________________________________________________________________________
How did you hear about the event? Friend Seniorific News Family Member Star-Telegram
Senior Center TAGs Radio/TV Church/Synagogue Library Neighborhood Assoc.
CUT HERE
7th Annual
2019 Title Sponsor
Other ____________________________________________________________________________
Have you attended the Expo in the past? Yes _____ No _____
If “YES”, check the previous year(s) attended: 2013 _____ 2014 _____ 2015 _____ 2016 _____ 2017____ 2018___
Send the completed form to
Kathryn Rotter via the following options:
MAIL: Tarrant County Judge Glen Whitley 100 E. Weatherford Street, Suite 501 Fort Worth, TX 76196
FAX: 817-884-2793 EMAIL: [email protected] For more information call 817-884-1234
To guarantee FREE box lunch
& FREE parking, registration form must be received no later
than Monday, April 26, 2019
Jueves, 9 de mayo 20198:30 a.m. - 1:30 p.m.
Will Rogers - Amon G. Carter Jr. Exhibits Hall
3400 Burnet– Tandy Drive, Fort Worth, Texas 76107
Senior Synergy Expo, un evento sobre la salud
para las personas de la tercera edad y los cuidadores.
Apúntese llenando este formulario o en el
sitio web: www.SeniorSynergyExpo.com
Formulario de Inscripción* (escriba con letra clara)
Ha asistido anteriormente a nuestra feria? Si__ No__ ¿Cuándo? □ 2013 □2014 □2015 □2016 □2017 □2018
¿Cómo supo de este evento?
Nombre:
Dirección:
Ciudad/Estado/Código postal:
Teléfono: Correo electrónico:
Edad: 18-24 25-34 35-44 45-54 55 75+
Si aplica, ¿cómo se llama su grupo o asociación? (ej. iglesia, hogar de ancianos, YWCA etc.)
Envíe el formulario a: Kathryn Rotter
Por uno de estos medios:
Correo electrónico: [email protected]
Tarrant County Judge Glen Whitley
100 E. Weatherford Street, Suite 501
Fort Worth, TX 76196
817-884-2793
Para garantizar su almuerzo
gratis y su estacionamiento,
esta solicitud debe ser recibida
antes del 26 de abril 2019.
Para más información comuníquese con: Kathryn Rotter en [email protected]
o llamando al 817-884-1234.
*Advertencia: La información provista será usada sólo para comunicarnos con usted acerca de este evento.
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Siete Anual
2019 Title Sponsor