Community Event Participation Request Form
Thank you for your inquiry for Baptist Health to participate in your event. Please complete the form below to help us better understand event details and determine how we can best support your efforts. Requests for event participation must be made at least 6 weeks in advance of the event.
Organization Name:
*
Contact First & Last Name:
*
First Name
Last Name
Contact Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Contact Email Address:
*
example@example.com
Event Title:
*
Event Location and Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Event Date:
*
-
Month
-
Day
Year
Date
Event Start Time:
*
Hour Minutes
AM
PM
AM/PM Option
Event Finish Time:
*
Hour Minutes
AM
PM
AM/PM Option
Event Set-Up Time:
*
Hour Minutes
AM
PM
AM/PM Option
Type of Event (select all that apply):
*
School Health & Safety Fair
Religious organization health fair
Neighborhood event
Community-wide health event
Health Awareness
Career Fair
Other
Please indicate the services you are requesting at your event (select all that apply):
*
Speaker
Biometric/Health Screenings
Health Information/Literature
Health Education
Other
Target Audience (select all that apply):
*
Adults
Children
Teens
Seniors
Expected Number of People Attending:
*
Event Setting
*
Indoor
Outdoor
Both
Other
If outdoor, will tents be provided?:
Yes
No
Will tables and chairs be provided?:
Yes
No
If yes, what size tables will be provided?:
Are tables covered or skirted?
Is event free for participants?:
*
Yes
No
Is event free for vendors?:
*
Yes
No
Is vendor parking free?:
*
Yes
No
Will other vendors be providing health information or resources?:
*
Yes
No
Will health screenings be provided by other vendors?:
*
Yes
No
How often does this event occur?:
*
One time only
Weekly
Monthly
Yearly
Other
Comments or Additional Event Details:
Questions for Us:
Submit
Should be Empty: