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Contact Us
Community Affairs

Speaker and Health Fair Request Form

Please note that The Health Department will not attend or promote events that require any monetary payments.

Type of Request (Please check one):
Target Group 
Speaker Request (lecture setting, non-health fair)
Health Topic  
Health Fair (tabling)
Health Topic 
Title of Event*
Date of Event*
Set-up Time *
Start Time *
End Time*
Event Location*
Street Address *
City *
State *
Zip Code *
How many people are expected to attend? *
Target Group*  
Preferred Language(s)*  
Are PowerPoint facilities available? *
How long will the Health Department presenter have to speak? *
Specific time for Health Department speaker (i.e., we get requests for all-day events but we need to know what time DOH staff need to be there) *
Host Organization(s) *
Contact Person *
Phone Number *
Cell Number
Email *
Date you need a response by *
Additional Notes (For example: materials provided for events such as chairs, tables, etc.)
If we cannot attend your health fair but you would like us to provide you with our health literature, please provide the address where our materials should be sent to.
* Please enter the letters you see in the graphic below (required):
(letters are not case-sensitive)
    Listen to and enter into the text field the digits you hear 

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