Health Fair / Community Event Request Form

Mission: To protect, promote & improve the health of all people in Florida through integrated state, county, & community efforts.

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Health Fair / Community Event Request Form


To request VCHD participation in a health fair/community event, please complete this form. Submission of this form does not guarantee VCHD participation in your upcoming event. Participation is based on staff availability and focus areas of our programs.
Today's Date:
Contact Name:
Daytime Phone:
Email:	Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.
Sponsor Organization:
Event Name:
Event Date:
Event Start Time:		Event End Time:
Event Address:	(Please include name of building)
Zip code (5 digits):
Anticipated number of attendees:
The Event is for:	(Please select all that apply)
Will this event be:
If outside, will shade be provided?
Will you be providing tables & chairs for vendors?
Specific program requests / additional information:
To ensure this response is being sent by a person and not a computer, please enter the number you see below in the box next to the number.

Page last updated: 10/4/12

Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a
public records request, do not send electronic mail to this entity. Instead contact these offices by phone or in writing.

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