CHAMPS 2015 Screener Registration Form

Welcome screeners for the 2015 Community Health and Men's Promotions Summit. In order to accomplish our mission and exhibit the best health fair Atlanta has to offer, your participation is absolutely essential. We look forward to it!

This year's event will be held at the Georgia World Congress Center, in Building A, Rooms A11-A14 on Saturday, September 12th, 2015 from 10 AM to 3 PM (We ask that all screeners try and stay for the entire day. Lunch will be provided. Details regarding the location and time of set up will be provided closer to the date of the event).

You will receive a confirmation of your registration at a later date. If you are providing a specific service to the participants i.e. health screenings, food demonstration, etc. there is no fee.

Go CHAMPS!

    Contact Information

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    Screener Information

    The information listed below will enable us to properly prepare for your organization participation in CHAMPS 2014 Health fair!
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    Total T-Shirt Quantity
    Small T-Shirt Size Quantity
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    Please bring:

    Any and all supplies needed to perform your service; we will not be able to provide any assistance other than table and chairs. The Georgia World Congress Center is not equipped to dispose of certain materials i.e. specimens, needles. Garbage cans will be available throughout the hall.

    Attention

    Any and all supplies needed to perform your service; we will not be able to provide any assistance other than table and chairs. The Georgia World Congress Center is not equipped to dispose of certain materials i.e. specimens, needles. Garbage cans will be available throughout the hall.
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    Questions:

    Please feel free to contact the Midtown Urology Outreach Department if you have more questions. Phone: 404-881-0966 ext. 117/212 or 404-913-4636 Fax: (404) 874-5902 e-mail: rbrown@midtown-urology.com (Rudy Brown) or champs.health@gmail.com