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VENDOR FORM - HEALTH DAY
Community Health Day & 5K Walk/Run Vendor Application
Section 1: Contact Information
Company name
Contact Person
Phone
Email
Website/Social Media
Section 2: Business Details
Type of Business/Organizations
Health/Wellness Services
Fitness/Nutrition
Mental Health
Food Vendor (must be healthly)
Nonprofit/Community Org
Retail (Apparel/Products)
Other
Brief Description of Services/Products
Section 3: Event Participation
Will you provide any of the following?
Free Health Screenings
Wellness Demonstrations
Giveaways/Free Samples for our Swag Bags
Educational Matrials
On-Site Sales
Raffles/Contests
Other
Section 4: Logistics & Setup
Booth Needs:
Standard (6 ft table)
Large (10x10 tent space)
Do you need access to electricity?
Will you bring your own table/tent/chairs?
Special Accomodations/Needs:
Section 5: Community Health Alignment
How does your business/organization support the health and wellness of BIPOC communities and their families?
Section 6: Agreement
Agreement
I understand this is a family-friendly, health-focused event.
I will arrive on time and stay for the full duration of the event.
I will maintain a professional, respectful presence.
I understand that submission does not guarantee participation.
I release 100 Black Men and event partners from liability for any damages or loss.
Signature
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Date
Month
Day
Year
Submit
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