Community Health Fair Vendor & Provider Registration

Organization Name

Service Category

Brief Description of Services Offered at the Fair
Words: 0

Website
If applicable, enter your organization's website URL.

Primary Contact Name and Title

Primary Contact Phone Number

Primary Contact Email Address

Day-of On-site Contact (if different)
Name and title of the contact person attending the event if different from primary contact.

Your First Name

Your Last Name

Your Email Address

Documents Attendees Should Bring
Words: 0Examples: ID, insurance card, proof of income.

Number of Representatives Attending
Enter the number of people representing your organization at the event.

Table/Booth Needs

Power/Electrical Needs
Words: 0Please specify if you require electrical outlets or special power arrangements.

WiFi/Internet Needs
Words: 0Indicate if you need WiFi or internet access.

Private or Semi-Private Space Needed
Words: 0Indicate your need for a private or semi-private area.

Setup and Breakdown Time Required
Please specify any special setup or breakdown time requirements.

Loading/Parking Needs
Words: 0Please describe any special loading or parking requirements.

Printed Materials/Brochures Being Brought and Quantity
Words: 0

Giveaway Items (if any)
Words: 0

Confirmation of Participation

I confirm that my organization will participate in the November 7 Community Health Fair.

Please confirm your organization's participation.

Photo/Video Consent

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