CHAMPS 2013 Exhibitor/Screener Registration Form

Welcome Exhibitors/Screeners for the 2013 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 on Saturday, September 7 from 10 AM to 3 PM.

Please complete this form to register.

You will receive a confirmation of your registration at a later date. Exhibitors will receive confirmation of their attendance after payment has been received.

If you are providing a specific service to the participants i.e. health screenings, food demonstration, etc. There is no exhibitor fee. If you are a pharmaceutical company, private company, etc. There will be an exhibitor fee required for your attendance before you will receive confirmation of your attendance. Thank you for your cooperation.

Go CHAMPS!

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    Contact Information

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    Exhibitor/Screener Information

    The information listed below will enable us to properly prepare for your organization participation in CHAMPS 2012 Health fair!
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    Total T-Shirt Quantity
    Small T-Shirt Size Quantity
    Medium T-Shirt Size Quantity
    Large T-Shirt Size Quantity
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    XXXL T-Shirt Size Quantity
    Please enter one response per row

    Please bring:

    Any and all supplies needed to perform/exhibit 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.

    Only For Exhibitors!

    Attention Screeners: If you are a providing screenings to our participants you do not have to fill out this section. Choose Not Applicable. Attention Exhibitors: You must fill out this section to complete your registration as an exhibitor. Your registration as a exhibitor is only valid after receipt of your donation/sponsorship.CHAMPS is run solely on dontions/sponsorships from. As a result, we would appreciate your donation within two-weeks of your registration. Thank you.
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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 or 404-913-4636 Fax: 404-549-3894 e-mail: Aasare@midtown-urology.com (Ms. Adwoa Asare-Kwakye) or champs.health@gmail.com