Community Health Fairs

Organization Name :

Contact Person:

Contact Email:

Contact Phone:

Event Title:

Event Date:

Event Location:

Event Address:

City:

State:

Zip Code:

Event Start Time:

Event End Time:

Event Setup Time:

Would you like door prizes?:

YesNo

Number of People Expected:

Minimum Attendance:

Maximum Attendance:

Describe Audience:

If you have specific topics that you would like addressed by Deaconess, please list them below.

Topic 1:

Topic 2:

Topic 3:

How many years have you had this event?:

By what date do you need confirmation of attendance?:

Additional Information: