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Prince George's County, MD Prince George's County, MD 

 




Community Health Fair or Event Participation Request


Thank you for your interest in Prince George's County Health Department services and programs.

Please note that all requests received at least 30 calendar days prior to the event start date will be considered after the electronic request form is submitted, and the response will be based on the availability of staff and resources.

An e-mail confirmation of form submission will be sent to the listed e-mail address after the “Send” button is clicked. Please note that submission of this request does not guarantee Health Department participation. A staff person will contact you to confirm Health Department participation in the event.
All fields marked with * are required.
   

General Information
Sponsor Name:
Event Name:*
Event Contact Person:*
Contact Phone Number:* (ex. 000-000-0000)
Contact E-Mail Address:*
Event Location/Address:
   

Event Dates and Time
Day 1
Date:* (ex. MM/DD/YYYY)
Event Starts at:* (ex. HH/MM/AM or PM)
Event Ends at:* (ex. HH/MM/AM or PM)
 
Day 2
Date: (ex. MM/DD/YYYY)
Event Starts at: (ex. HH/MM/AM or PM)
Event Ends at: (ex. HH/MM/AM or PM)
Cancer (Breast, Cervical or Colon)
Cardiovascular (Heart) Disease
Diabetes/High Blood Sugar
Health Insurance for Pregnant Women and Children (MCHP)
Lead Testing (Environmental and in Children)
Mental Health
Nutrition/Eating Healthy
Obesity
Osteoporosis
Physical Activity, Exercise and Healthy Lifestyles
Prenatal Care
Public Health Emergency Preparedness
Sexually Transmitted Diseases (STDs ) and HIV/AIDS
WIC Foods for Women, Infants and Children
Substance Abuse (Alcohol, Drugs and Other Addictive Substances)
General Health Department Services Available to County Residents
Other (Specify):

Please provide all information possible
 
Audience (who will attend your event; for example, teens or families with children, etc.)
Is the event indoors, outdoors or both?

Approximate number of persons anticipated to attend event.
 
Are tables and chairs provided?

 
If the Health Department is unable to participate in your event, would you like to pick up educational materials from the Headquarters Building, 1701 McCormick Drive, Largo MD 20774?

 
Are there any exhibitor fees?

  If so, what is the fee? Fee: $
 
Would you be interested in having the American Red Cross attend your event to co-sponsor a blood drive? Yes No

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