FOP 10th Annual Health & Safety Fair Vendor Interest Form
Health Fair Date: Wednesday, July 18, 2018, 11AM - 3PM @ TVP II Community Center, 5000 Conner, Detroit MI 48213. Please complete form by June 22, 2018.
1. Organization name (This will be listed on all promotional material): *
Your answer
2. Organization address: *
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3. Primary Organization Contact person: *
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4. Office/work phone: *
Your answer
5. Cell phone:
Your answer
6. Fax:
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7. Email: *
Your answer
8. Contact person for health fair (if different from above):
Your answer
9. Office/work phone:
Your answer
10. Cell phone:
Your answer
11. Fax:
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12. Email:
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13. Primary target audience:
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14. Staff: *
Please list all staff that will be representing you at your booth and their titles.
Your answer
15. Services that you will provide at health fair: *
Required
16. If yes for counseling services, what services will you provide?
Your answer
17. If yes for screening services, what services will you provide?
Your answer
18. If yes for awareness informational, please specify
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19. If yes for giveaways, what items?
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20. If yes for health professional speaker, please provide name
Your answer
21. If yes for workshop, what workshop will you provide?
Your answer
22. If yes for workshop using classroom facility, how much time would you like for your presentation?
23. You will be provided with (1) regular six-foot table and (2) chairs. If you need additional items, please indicate below and we will do our best to accommodate you:
24. How will you be paying the $25 vendor fee? *
Please make checks out to Friends of Parkside and mail to: 5000 Conner, PO Box 13168, Detroit, MI 48213.
25. If yes for in-kind/donations, please include specifics and indicate monetary value:
Your answer
26. Comments/Questions/Suggestions
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