Health Fair Request Form

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Health Fair Request Form

We are only able to participate in health fairs in the National Capital Area Chapter's service territory. If you are outside our service area, see this page to find your local chapter of the Alzheimer's Association.
*required fields.

*Organization

*Event Name

*Event Date

*Event Time

*Event Location

*Is this a workplace giving campaign event?

*Contact Person

*Phone number:

Fax

*Email address:

*Anticipated number of attendees

*Alzheimer's Association representative required? No
Yes

*Early Materials Drop-Off? No
Yes

*Materials Held Post-Event? No
Yes

*Parking Available? No
Yes-Free
Yes-Paid Fee

*Accessible via Metrorail? No
Yes

*Meal Provided (if applicable) No
Yes (free)
Yes (paid fee)

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© 1997 - 2005 Alzheimer's Association, National Capital Area. All rights reserved.
703-359-4440 or toll-free 1-800-272-3900

*Organization
*Event Name
*Event Date
*Event Time
*Event Location
*Is this a workplace giving campaign event?
*Contact Person
*Phone number:
Fax
*Email address:
*Anticipated number of attendees
*Alzheimer's Association representative required?	No Yes
*Early Materials Drop-Off?	No Yes
*Materials Held Post-Event?	No Yes
*Parking Available?	No Yes-Free Yes-Paid Fee
*Accessible via Metrorail?	No Yes
*Meal Provided (if applicable)	No Yes (free) Yes (paid fee)