LJC Health Fair Form

Lansing Juneteenth Celebration: Health Fair Participation Form
WE LOOK FORWARD TO HAVING YOU JOIN US FOR OUR ANNUAL JUNETEENTH CELEBRATION HEALTH FAIR. PLEASE NOTE THE FOLLOWING:
- All health fair participants are required to purchase an ad, using the advertising form available at the Juneteenth website.
- If you have questions, please contact us by email at healthfairjuneteenth@gmail.com.
Company Name *
Please enter the name of the organization, business, political figure, etc.
Coordinator Name *

First Name Last Name
Organization or Contact Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone Number *

Area Code Phone Number
E-mail *
Staff members attending the event: *
Service Description *

THIS IS A NON-PROFIT ORGANIZATION: An Advertising form has been/will be included in addition to this participation form. We will use the complimentary table and two chairs provided in the health tent. THIS IS A NON-PROFIT ORGANIZATION: An Advertising form has been/will be included in addition to this participation form. A vendor form is also included for a space outside of the health tent.
Please briefly describe your display/booth: *
Please provide a brief statement of any Awareness/Information to be announced: *
Giveaways (if any):
Should be Empty:

Lansing Juneteenth Celebration: Health Fair Participation Form