Health Fair Participation Request Form

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Planning a health fair? Please complete this form to request participation from the Wicomico County Health Department. Please give us at least 3 weeks notice.
Our Health Fair committee will review your request and schedule staff to participate.

The Health Department is unable to pay any exhibitor fees to participate.

REQUIRED FIELDS MUST BE COMPLETED FOR SUBMISSION TO BE RECEIVED.

Sponsoring Agency or Organization

Event Name *

Event Location Address *

(Please note if event is held outdoors.)

Event Date *

YYYY

Event Time (Start to End) *

Contact Person *

Contact email and telephone number *

Number expected to attend

Please tell us about your audience.

(Male/Female, children, adults, etc.)

Are there specific health topics / programs that you would like us to address?

Is electricity available? *

Yes

Are tables/chairs provided? *

Yes

Would you like us to include literature/written materials in other languages if available? (We have some literature available in Spanish and Haitian Creole) *

Depending on your expected audience, would a Spanish or Haitian Creole interpreter be helpful? (We can not guarantee the availability to provide an interpreter) *

Yes

Are there any specific details you would like us to know?

(Example: Is event indoors or outdoors? Special instructions for vendors?)

If this event is open to the public, Can the Wicomico County Health Department add your event to their website calendar?

If you have a flyer you'd like to share, please email it to emily.deckert@maryland.gov

Yes

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