The Meeting Place
The Meeting Place
Community Health Fair Guest Registration
Please fill out this form to register for The Meeting Place Church's November 7 Community Health Fair. Fields marked as required must be completed. The form is organized into clear sections for your convenience.
Personal Information
First Name
Last Name
Phone Number
Email Address
Home Address or ZIP Code
Number of Household Members Attending
Please enter a number.
Ages of Attendees or Age Ranges
You may enter individual ages or age ranges (e.g., 5, 12-14, adult).
Needs & Interests
Services of Interest
General Health
Eye Care
Mental Health
Dietary/Nutrition
Other
Dental
Hearing
Physical Therapy
Insurance & Enrollment
Select all services you are interested in.
Current Insurance Status
-- select an option --
Yes
No
Not sure
Richland County Resident?
-- select an option --
Yes
No
Preferred Language
Accessibility
Mobility or Accessibility Accommodations Needed
Words:
0
Please describe any accommodations you require.
Interpreter/Translation Needed
Words:
0
Please specify language or type of interpreter needed.
Communication Preferences
How Did You Hear About the Health Fair?
Email Reminder Opt-in
Yes, I would like to receive email reminders about the November 7 Community Health Fair.
Text Reminder Opt-in
Yes, I agree to receive text-message reminders from The Meeting Place Church about the November 7 Community Health Fair at the phone number provided. Message and data rates may apply. Reply STOP to opt out and HELP for help. Consent is not a condition of attending.
Follow-up Contact Consent
Yes, TMPC may contact me after the health fair for follow-up.
Consent
Photo/Video Release Consent
-- select an option --
Yes, I consent to being photographed/filmed during the event for TMPC communications and marketing
No, I do not consent
Submit
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