HVC Unpacking Family Baggage Exhibitor Registration
Exhibitor Registration for the Mental Health Resource Fair, April 22, Pascack Hills High School 6-7pm
Name (Last, First)
Exhibitor/ Agency Name
Agency Street Address
Agency Telephone #
I will attend
Mental Health Resource Fair 6-7pm
Claudia Black, Ph.D. Keynote Presentation 7-9pm
Both Mental Health Resource Fair and Keynote Speaker
Exhibitor Sponsorship Donation
Bergen County Agency -Gratis
Self-Help Support Group-Gratis
Friend of HVC Donation ___________
Mail to: Hills Valley Coalition, c/o Gale Mangold PHHS 225 West Grand Ave, Montvale, NJ 07645
Affiliation or Organization
Mental Health or Addiction Treatment Provider
Bergen County Program
Medical/Hospital Treatment Center
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Pascack Valley Regional H.S. District.