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.
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Sponsoring Agency or Organization
Event Name *
Event Location *
(Please note if event is held outdoors.)
Event Date *
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Event Time (Start to End) *
Contact Person *
Contact email or telephone *
Number of Expected Participants
Please tell us about your audience.
(Male/Female, children, adults, etc.)
Are there specific health topics that you would like us to address?
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?)
Can the Wicomico County Health Department add your event to their website calendar?
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