Health Fair Participation Request Form
Planning a health fair? Please complete this form to request participation from Wicomico County Health Department.
Our Health Fair committee will review your request and schedule staff to participate.

REQUIRED FIELDS MUST BE COMPLETED FOR SUBMISSION TO BE RECEIVED.

You will receive a confirmation message when you have successfully competed your entry.
Sponsoring Agency or Organization
Your answer
Event Name *
Your answer
Event Location *
(Please note if event is held outdoors.)
Your answer
Event Date *
MM
/
DD
/
YYYY
Event Time (Start to End) *
Your answer
Contact Person *
Your answer
Contact email or telephone *
Your answer
Number of Expected Participants
Your answer
Please tell us about your audience.
(Male/Female, children, adults, etc.)
Your answer
Are there specific health topics that you would like us to address?
Your answer
Is electricity available? *
Are tables/chairs provided? *
Are there any specific details you would like us to know?
(Example: Is event indoors or outdoors? Is there an exhibitor fee? Special instructions for vendors?)
Your answer
Can the Wicomico County Health Department add your event to their website calendar?
Submit
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