Healthy Day Vendor Form | 100 Black Men of Metro STL

Community Health Day

Run/Walk Vendor Application

Section 1: Contact Information

Company name

Contact Person

Phone

Email

Website/Social Media

Section 2: Business Details

Type of Business/Organizations

Brief Description of Services/Products

Section 3: Event Participation

Will you provide any of the following?

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: Please upload Certificate of Insurance

Upload an Image or PDF

Section 7: 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.

I understand there is a non-refundable vendor registration fee of $100.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Date

Month

Day

Year

Vendor Registration Fee

$100

You will be taken to the payment site after submission. Only submissions with a valid payment and order number will be accepted.

VENDOR FORM - HEALTH DAY