Address (include City and Zip Code):
Please Check One:
Yes, I would like to confirm my participation in the Community Health Fair. I will send the $30 registration fee made payable to Viterbo University.No, I will be unable to participate in the Community Health Fair.
Please give a brief description of your services/screenings/demonstrations for the Health Fair:
Equipment: Please indicate the number of chairs and tables you will need. One table and two chairs are included with the participation fee. If more tables and chairs are needed please specify below.
Additional Tables: One table provided, extra tables will cost $10 each.Additional Chairs:
Will you need a table covering to be supplied for your booth? YesNo
Electrical Access: Will you require electrical access? YesNo