Mobile Health Collaborative                           Vendor Registration                                       SPRING HEALTH FAIR                                       Saturday April 15, 2023                                     10 AM-2 PM                                                         Price Recreation Center                                       2050 Bonnie Lane 
Thank you for joining us on Saturday April 15. You will hear from us to confirm your registration.   Detailed Instructions will be sent closer to the event.  This will be an event truly dedicated to understanding what needs to happen to bring healthcare to this neighborhood.  THIS IS OUR THIRD EVENT AT PRICE AND WE ARE INVITING ALL VISITORS WHO ATTENDED AND TOOK ADVANTAGE OF OUR SERVICES AT OUR FALL AND WINTER EVENTS TO ATTEND THIS EVENT FOR FOLLOW UP.  
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Organization *
Contact first name *
Contact last name
Contact phone number *
Contact email address *
What services will you be providing? *
All services at this event are free- even for those with insurance.  For follow up care- does your organization accept MEDICAID ?  *
Do you have the ability to assist visitors in checking their eligibility for Medicaid- or signing up for coverage?  *
Will you need power? *
Will you need Wi-Fi access? *
Do you have a preference on being placed inside in the gym, inside in a more private location,  or outside (in a mobile vehicle)? *
Do you have access to bus passes or transportation to your organization for follow up care?  *
Can you schedule future appointments from the event site? *
Who is your target population? *
Select all that apply
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