CelebrAsian Vendor Application

Health and Wellness Information
Business/Non Profit Name*
Contact Name*

First NameLast Name
Tax ID/EIN Number*
E-mail*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Type of Organization*
Days you plan to attend *
If you are a registered 501c3 nonprofit, please provide a brief description about your organization and how it serves the community.

Payment
Payment Method

Credit/Debit Card (3% Processing Fee)Mail Check (Follow Directions Below)
For registration of the Health & Wellness or Community Village a flat fee of $250 is required and Due Monday May 5th.

Please make check(s) payable to Iowa Asian Alliance.

Mail check(s) along with the form to IAA’s billing address:

Diversified Management Services
Attn: IAA CelebrAsian
1415 28th Street, Suite 400
West Des Moines, IA 50266

Phone: (515)282-8192
Total

Credit card total

USDDescription

Credit Card

Apple Pay

Google Pay

CelebrAsian 2025 Health and Wellness Registration Form