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Event Vendor Application

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Event Vendor Application

Event Vendor Registration Is Now Open

Please select a health fair that you like to register:

Please check all that apply: required*

El Dorado Health Fair, September 16, 2023 at 12pm - 3pm | Municipal Auditorium Lobby, 100 W 8th St, El Dorado, AR 71730 Pine Bluff Health Fair, November 4th, 2023 | White Hall Community Center, 9801 Dollarway Rd, White Hall, AR 71602

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Name of Organization *

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Organization Type

Contact Name *

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Position

Phone

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Email *

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Alternate Contact Name

Phone

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Email

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Address

City

State

Zip Code

Briefly describe your booth or display:

What type of health screenings or other services will your booth provide?

Equipment

AHW will provide each vendor with 2 chairs. Do you need additional chairs?

Yes No

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Number of additional chairs needed:

AHW will provide you with one six-foot table. Do you need additional tables?

Yes No

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Number of additional tables needed:

Do you need electricity? (Arkansas Health and Wellness will not be supplying extension cords or power strips. If needed, you must bring your own.)

Yes No

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Do you need extra space?

Yes No

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If so, please specify what the need is for and how much space is needed:

Will you provide screenings that require a private room?

Yes No

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Provide any additional information on screenings:

Will you provide an item for our raffle?

Yes No

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Will you stay during the entire event?

Yes No

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Error: Please complete the captcha by selecting the checkbox, I am not a robot.

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