Registration For LA Health Fair

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Registration For LA Health Fair - Jan 7

Please complete this form to confirm your organizations participation in the Health Fair on Jan 7. For further questions, please contact LA@ematai.org. We look forward to working with you!

You will receive a follow up email to confirm your organizations participation.

* Indicates required question

Email *

Record my email address with my response

Name of Organization *

Your answer

Is Your Organization a For-Profit or Non-Profit? *

Profit

Non-Profit

Your Full Name *

Your answer

Your Role at the Organization *

Your answer

Your Email Address *

Your answer

Your Phone Number *

Your answer

Any Special Requests?

Your answer

A copy of your responses will be emailed to .

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