Health Fair Request Form

Completion of this request form does not guarantee participation by the Association. The Education and Training Coordinator will contact you to discuss your interest and make final arrangements.

All mandatory fields are indicated with an asterisk (*) and must be completed or form submission will be rejected.

*Event Date
*Event Time
*Organization
*Contact Person
*Phone number:
Street Address
City
State
Zip Code
Is this a home or work address?	Home Work
Fax
*Email address:
*Anticipated number of attendees
Early Materials Drop-Off?	No Yes
Parking	No Yes-Free Yes-Paid
Public Transportation	No Yes
Meal Provided (if applicable)	No Yes