Note: submission of the request is not a confirmation. Name of your event: Address where your event will be held: Date of event: Expected attendance (#): Time of event: Contact name: Phone number: Email (required): Target audience: If school, will kids come with teacher for: Set amount of timeJust "fly by" Goals/theme of fair: Topic(s)/display(s) requested: 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: Health related article in newsletter or websiteAllow us to post national campaign (i.e. “Diabetes Alert Day”) posters at your facilitySpeaker 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? Check all that apply: WIC, Women, Infants, and ChildrenHANDS, Health Access Nurturing Development ServicesHarm Reduction Needle Exchange program, NARCAN trainingPublic Health Clinic - Info only, STD, ImmunizationsEnvironmental Services - Info only, mosquito control, bedbugs, rabies, septic system tips, etc.