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Event Vendor Application
Event Vendor Registration Is Now Open
Please select a health fair that you like to register:
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Provider Summit September, 2023
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Name of Organization
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Contact Name
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Position
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Email
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Alternate Contact Name
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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?
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Number of additional chairs needed:
AHW will provide you with one six-foot table. Do you need additional tables?
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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.)
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Do you need extra space?
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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?
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Provide any additional information on screenings:
Will you provide an item for our raffle?
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Will you stay during the entire event?
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