Application Form
Please complete this application to participate as a vendor/partner. Space is limited and confirmed on a rolling basis. Table is 6-ft in size and you would need to bring your own setup for your booth.
Organization/Business Name:
Primary Contact (Name &Title):
*
First Name
Last Name
Phone Number:
*
-
Area Code
Phone Number
E-mail:
*
Participation type (check all that apply):
*
Information/Education Table
Health Screenings/Clinical Services
Wellness Activities (yoga, massage, fitness demo, etc.)
Community Resources/Enrollment (e.g., Medicaid, Food & Nutrition)
Product Sampling/Giveaways (in-kind)
Other
Description of Services/Activities/Screenings:
Space & Logistics
Power Needed:
Yes
No
Wi-Fi Needed:
Yes
No
Chairs Needed:
One
Two
Three
Other
Arrival Time (recommended 9:00AM-9:30AM), will that be okay?
Yes
No
Other
Agreement
By signing below, I affirm that the information provided is accurate. I agree to follow event guidelines, arrive on time for setup, and ensure my area is staffed for the duration of the event (10:00 AM–3:00 PM), or if otherwise noted. I understand that all giveaways must be provided at no cost to attendees unless otherwise approved.
Submit
Should be Empty: