HEALTHY HEROES, HEALTHY COMMUNITY
Share your organization details and how you’d like to participate in the community health event. Deadline to submit application: October 9, 2026.
Organization Information
Organization Name
*
Organization Type
*
Please Select
Healthcare Provider
Nonprofit or Community Organization
Government or Public Agency
First Responder or Public Safety Agency
Fitness or Wellness Organization
Educational Organization
Business
Other
Primary Contact
*
First Name
Middle Name
Last Name
Title or Position
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Website or Social Media Page
Participation Interests
How would your organization like to participate?
*
Provide a health screening
Share health or wellness information
Provide community resources or referrals
Offer an educational activity or demonstration
Provide an interactive activity
Volunteer or assist with the event
Other
Please describe how you would like to participate
What health or community needs does your organization address?
*
Heart and Cardiovascular Health
Primary or Preventive Care
Women’s Health
Men’s Health
Mental or Behavioral Health
Nutrition
Physical Activity and Fitness
Diabetes
Cancer Prevention or Support
Family and Children’s Health
Healthy Aging and Senior Services
Substance Use
Recovery or Treatment
Healthcare Access or Insurance
Safety and Injury Prevention
Social Services or Community Support
Other
Service and Setup Needs
Will you provide a screening, testing service or other hands-on health service?
*
Yes
No
Not sure yet
Please describe the screening or service
Does the screening or service require privacy, electricity, water or other special arrangements?
Approximately how many representatives will attend?
*
What setup items do you expect to need?
*
Access to electricity
Space for a freestanding display
Space for an interactive activity
Private screening space
Other
Requests will be reviewed based on availability. Event staff will confirm final arrangements before the event.
Please share any additional setup needs, questions or information
Branding and Agreement
Organization Logo
Upload a File
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Promotional Permission
*
I authorize Healthy Heroes, Healthy Community and its presenting organizations to list our organization as a participating partner and use our submitted name and logo in event-related materials.
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