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Event registration
Event Timing: November 7, 2026
Event Address: Mercer Mall, Mercer Mall Blvd, Bluefield, WV 24701
Contact us at (304) 327-7114 or info@firstmediaservices.com
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Email
*
Your email
Business/Organization Name
*
Your answer
Contact Person
*
Your answer
Phone Number
*
Your answer
Business Address
Your answer
City, State, & Zip
Your answer
Website, Facebook Page and other Social Media (Tagging puposes)
*
Your answer
Choose Your Showcase Area
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Health & Wellness Showcase
Women's Pavilion
Holiday Marketplace-Merry Mercer Market
Other/Cross Category
If you selected Other/Cross Category, please explain:
Your answer
Tell Us About Your Booth- Briefly explain how your business/org wants to feature at the Healthy Living Showcase:
Your answer
Will you be selling Merchandise?
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Yes
No
If yes, what products or merchandise will you be selling?
Your answer
Will your booth provide any of the following?
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Health Screening
Demonstration
Consultation
Educational Information
Product Samples
Children's Activity
Other Activity
Food or Drinks
None
Other:
Required
What size booth/display space are you requesting?
6' Table
12' Table
10' X10' space
10' X 20' space
10' X 30' space Enhanced Booth Space or Large Display
Larger Display Area Needed
Other:
Clear selection
If you picked Larger Display Area, please add in the description.
Your answer
Table Needed-*Tables are limited, first come, first serve
*
No Table
One 6' Foot Table
Two 6' Table
Other:
Chairs Needed
None
One
Two
Other:
Clear selection
Do you require electricity? ***Bring extension cords
Yes-Standard Electricity
No
Clear selection
If yes, what equipment will need electricity?
Your answer
Do you require WIFI or internet?
Yes
No
Maybe
Clear selection
Do you need additional space behind your booth or around your booth for equipment or demonstrations?
Yes
No
Clear selection
If yes, explain.
Your answer
Please select any special requirements that apply to your display.
Health Screening Area
Private/Semi-Private Consultation Area
Demonstration Space
Televison/Monitor
Large Display or Banner
Product Display Racks
Clothing Racks
Floor-Standing Display
Medical Equipment
Wheelchair/Accessibility Considerations
Food/Sampling Area
Additional Electrical Area
None
Option 14
Other:
Approximately how tall is your tallest booth display?
Your answer
Are you planning any of the following?
Door Prize/Giveaway-ENCOURAGED
Free Samples
Health Screening
Live Demos
Chidren's Activity
Holiday Shopping Special
Show-Only Discounts/Promotion
Educational Materials
Other:
Would you be willing to promote this event on your own social media pages and tag the venue and sponsors?
Yes
No
Clear selection
Event Day Contact
Name of Person(s) responsible for your booth on event day
Your answer
Event Day Cell Number
Your answer
Payments must be paid prior to event date by 10/15/2026...depending on package plan.
*
Your answer
A copy of your responses will be emailed to the address you provided.
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