DCBOH Men’s Health & Wellness Fair: Screener & Vendor Interest Form
Thank you for your interest in the DeKalb County Board of Health (DCBOH) Men's Health and Wellness Fair.

The mission of the fair is to connect the men of DeKalb County to medical care through screenings, education, and referrals. This fair will provide a valuable service to the community so that men are better equipped to care for themselves and in turn care for their families and communities.

Anticipated attendance is 300.

Please complete this form by Friday, April 19th, 2019.

If you have questions, contact the DeKalb County Board of Health at 404-508-7847 or dekalb.ocdp@dph.ga.gov.

Saturday, June 29, 2019
11 a.m. to 3:00 p.m.
Georgia Piedmont Technical College
Conference Center
495 North Indian Creek Drive
Clarkston, GA 30021

Completion of this interest form does not guarantee or confirm participation in the health fair. Final decisions will be made by the DeKalb County Board of Health Men’s Health & Wellness Fair Committee to ensure compliance with our stated mission.

Note: Confirmed vendors and screeners will be provided with one 6 or 8 foot table and two chairs.


Email address *
First Name
Your answer
Last Name
Your answer
Company Name
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Address
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City
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State
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Zip code
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Website
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Phone Number
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Are you registering as a Vendor or Screener?
Booth ID Name (if different from Company Name / this is how you will be recognized)
Your answer
Type of Health Information provided (if applicable):
Your answer
Type of Service to be provided: *
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