Note: submission of the request is not a confirmation. Name of your event: Address and name of building where your event will be held: Date of event: Expected attendance (#): Event start time and end time: Contact name: Phone number: Email (required): Target audience (example: students, teachers, adults, families, employees, etc.): If school, will kids come with teacher for: Set amount of timeJust "fly by" Goals/theme of fair: Topic(s)/display(s) requested: Topics of presentation: NutritionHygieneDiabetesTobacco How is the fair being promoted? Will it be indoors? yesno If not, will there be a tent provided? yesno Will there be tables and chairs set up? (displays need a 6’ long table each): yesno Other set-up instructions: We would like to partner throughout the year, can we schedule one of the items below? yesno Check all that apply: Speaker on health topic for employee lunch ‘n learn or support groupConsultation on food available to target audience (vending areas, cafeterias, mtgs)Can we join your health team meetings?