MSOE Health Fair Participant Application

MSOE Health & Wellness Fair

April 22nd, 2010

11 a.m. - 3 p.m.

Campus Center Room 130, 1025 N. Broadway

MSOE's Annual Health and Wellness Fair is sponsored by MSOE Health Services and the School of Nursing to promote individual health and wellness for our college campus and the greater Milwaukee community as well as addressing public health concerns. There is no charge to attendees or participants, although we do require all participants to consider a free screening, and a giveaway of your service or product at your own table drawing or in our general drawing, or both! Please note, we are changing the location of our health fair this year to our Student Center. Thank you for taking your time to fill out our participant and donor applications. Your application will be reviewed for selection and you will be contacted in February if you are to be involved in the Health Fair.

Are you able/committed to attend the Health Fair this year?

		Yes
		I am unable to attend but would like to be on your contacts list

Would you like to remain on our contact list?

		Yes
		No

Name of Organization:

Address:

City:

State:

Zip:

Person Attending (including job title):

Contact Person (including job title):

Telephone:

Fax:

E-mail: (All communications will be made by e-mail, please specify if written communication if preferred)

Website:

Brief Description of Screening or Demonstration:

There is not a cost for participating in the Health Fair however we do require that you provide a giveaway item at your table or for our general drawing.

Donation for your own Table Drawing (if any):

Donation Item for General Drawing (if any):

Items needed for Display:

6' Tables:

		0
		1
		2

Chairs:

		0
		1
		2
		3
		4

Audio/Video Needs (Limited Supply-if able to bring your own this is greatly appreciated):

		TV
		VCR
		DVD Player

We've been having some problems with people not knowing if their information has been submitted.� When you hit submit, if it takes you to the MSOE home page, you know your information has been received.� Thank you very much for your time!

Please note: it is at the discretion of MSOE Health Services to determine which vendors would be the best fit for the MSOE Community. Not all applicants are always accepted