Registration Form
Honor Your Health 2019!
26th Annual Health Fair!
Saturday, October 12th 2019, 9-2 at University of Connecticut-Stamford
1 University Place, Stamford, CT (set-up at 8 AM)

To be apart of our fair we require this form to be filled out.

Agency Name *
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Agency Address *
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PRIMARY Contact Person: *
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PRIMARY Email Address *
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SECONDARY Contact Person *
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SECONDARY Email Address *
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Service(s) to be provided: *
Your answer
Number of tables, chairs needed? What equipment will you bring: *
Your answer
Do you have any need for: electricity, water, HIPPA privacy, space; other ? *
Your answer
Do you have any special needs? If so, describe your special need: *
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Describe your exhibit (what you will be offering): *
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Do you want to be a SPONSOR, SUPPORTER or DONOR? *
Fees: For-Profit Businesses: $200 per table (No-cost for sponsors)
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Fees: Non-Profit Businesses: $100 per table (No-cost for sponsors)
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ALL CHECKS ARE DUE BY 9-14-19 Write Checks to FOUNDATION OF HOPE (our tax-deductible 501(c)(3) fiduciary); Write “ HONOR YOUR HEALTH 2019!” on Memo Line. Mail Registration/Sponsorship/Donor checks to: Foundation of Hope P.O. BOX 605 Greenwich, CT 06830
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