25th Annual Health Fair Registration Form Organization Name(Required)DepartmentContact Name(Required) First Last Mailing Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required)FaxEmail(Required) Website(Required)Program/Service/Activity Description(Required)Will you have additional equipment with you or require additional space?(Required) Yes No If yes, please explain:Do you have any other special requests?(Required) Yes No If yes, please explain:
