Registration Form

2nd ANNUAL Health & Wellness Fair Registration Form

Sound MIND, Sound BODY
To participate,

fill out the information below and send online by clicking "SUBMIT", return by email: ckelly@psycamore.com, by fax: 662.349.3406 or in person: 7165 Getwell Rd. Bldg-G, Southaven, MS
Full Name*

First NameLast Name
Company Name*
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Product Category*

Medical/HealthcareBehavioral Health and TheraryNutritionYoga/Mindful ActivitiesLab Testing & Preventative ScreeningsMassage TherapyPhysical FitnessSports FitnessWholistic foods & vitaminsChiropracticPreventative Health/Mindful HealthcareOpticalHospitalRelaxation TechniquesEverything Else
Description of your Services, Presentations and/or Demonstrations :*
Will access to electrical outlet be required?
25 spaces available with electrical access. Available on a first come basis.
Let us know if you would like to set-up a scheduled presentation, informative lecture or workshop/class :
first come basis, subject to availability of time slots
Preferred Time - First Choice

:HourMinutesAM/PM Option
Preferred Time - Second Choice

:HourMinutesAM/PM Option
*Optional - Attach photos of your logo here:

Upload a File
Accepted file formats: GIF, JPG and PNG Cancelof
Social Pages
Website:
Facebook Page:
Twitter ID:
Google+
Participation Fee: $100

Cash, checks or credit cards are acceptable. Contact Corey Kelly for payment arrangements: cell-901.878.9098 or office- 662.349.2818 Payment is due in full to be guaranteed participation in this event. Once the form is submitted, payment is expected in full.
PLEASE NOTE: YOU ARE NOT A PARTICIPANT IN THE HEALTH FAIR UNTIL PAYMENT IS MADE IN FULL.

IN CASE OF INCLEMENT WEATHER CONDITIONS, ALL PARTICIPANTS WILL BE PROVIDED WITH A RAIN DATE (RESCHEDULED DATE) AT NO ADDITIONAL COST.
What the Fee Covers

The activity fee covers the use of display/booth space at Tanger Outlet Mall on the day of the fair, the use of one 6ft rectangular table and 2 chairs during the event, all advertising for the event and all promotional activities (contests, drawings, give-aways, prizes, etc.) during the event.
Contact:

For more information, or any questions, please contact Corey Kelly at Psycamore Psychiatric: 662.349.2818 by email: ckelly@psycamore.com OR cell: 901.878.9098.
Take a look at the highlights from last year...

https://youtu.be/eKTfHYol8j8
Should be Empty:

2nd ANNUAL Health & Wellness Fair Registration Form

To participate,

Social Pages

Participation Fee: $100

What the Fee Covers

Contact: