Pop-Up PHC
Pop-Up PHC will be held each Tuesday from 8am to 1pm at 1401 N. Las Vegas Blvd. Please join us for this collaborative event to provide outreach and services to people experiencing homelessness.
What service will you provide at Pop-Up PHC?
Name of your organization
Your answer
Dates of Interest (Select all that apply)
Required
Each booth comes with 1 table and 2 chairs (unless otherwise specified)
# of tables requesting
Your answer
# of chairs requesting
Your answer
Electrical Needs
Do you need electricity?
Internet Connection Needs
Do you need internet connection? *Not guaranteed
Do you have a shade tent available?
Do you have a mobile unit from which you will provide services?
Contact Person
Your answer
Address
Your answer
City, State, Zip Code
Your answer
Phone Number
Your answer
Email Address
Your answer
Please provide a description of the programs or services provided at Pop-Up PHC
Your answer
Will your organization be providing bus passes for follow-up appointments?
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