Health Fair Application

Thank you for your interest in having HopeHealth attend your event. While we make our best effort to attend as many community events as possible, we are unable to attend all of them due to the high volume of requests received. All requests must be received at least 60 days prior to the event. Upon receipt of request, an acknowledgement is sent to the applicant. The review and approval process may take up to three weeks.

Once the event has been accepted, HopeHealth guarantees attendance for a maximum of four hours, the times in which the host may specify. We ask that the event host (your company) supply HopeHealth with a table, four chairs, and three-prong outlet access. If you are requesting screenings, our preference is to be indoors. HopeHealth will provide educational and marketing material for each event as appropriate.

Your application submission is your agreement to abide by the policy and guidelines set forth above.

Health Fair Application

Please fill out the form below

What is the name of your organization? *

What is the name of the event? *

Please describe your event *

Date of the Event *

Start Time of the Event *

121234567891011 : 0030 AMPM

End Time of the Event *

121234567891011 : 0030 AMPM

Name of Event Location/Venue

Event Address *

Event Address

Event Address

Event Address

City

City

State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

State/Province

Zip/Postal

Zip/Postal

Number of people expected to attend *

Event Demographic (age, race, etc...) *

Event Contact Name *

Telephone Number *

Email address *

Has HopeHealth participated in this event before? * YesNoUnsure

Please check services requested *

Blood pressure screenings

Body mass index screenings

Glucose screenings

Women's health - self breast exams and education; pap smear education

HIV testing (Monday - Thursday only)

HIV information

Marketing only

Other

If 'other' was selected in the previous question, please specify needs

In fifty words or less, please summarize your event *

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