Mind, Body, & Ballot Health Fair
Registration Form
Organization Name
*
Contact Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Vendor Type
*
Testing/Screening
Demonstration
Information
Community Resource
Food/Snacks/Drinks
Other
Testing or Screening Provided:
Vision
Dental
BMI
Cholesterol
Glucose
Blood Pressure
Mammogram
Colon Screening Kits
Sexually Transmitted Disease
Diabetes
Blood Donation
Mental Health
Other
Demonstration Provided:
CPR
Personal Safety
Cooking/Healthy Lifestyle
Voter Education
Massage
Stretching
Other
Please elaborate on the type of testing, information, or resources you provide
*
Please be detailed
Any special setup requirements?
No guarantee that special requirements can be accommodated.
Submit
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