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Vendor Participation Application
Vendor Participation Application
NOTE:
All vendors must provide a service to low income and/or homeless individuals.
NO SELLING WILL BE PERMITTED.
Event Name
(Required)
--Select--
Springtime Community Health & Wellness Event
Back-to-School Backpack Event
Eat & Be Well
Holiday Giving Event
Contact:
(Required)
Location:
Date:
(Required)
MM slash DD slash YYYY
Time:
Hours
:
Minutes
AM
PM
AM/PM
Organization:
(Required)
Type of Organization:
(Required)
Nonprofit
Business
Address:
(Required)
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone:
Email:
(Required)
Fax:
Number of Representatives Attending:
(Required)
Names of Representatives Attending:
(Required)
Contact Numbers (Onsite):
(Required)
Nature of Materials and/or Information to be Provided:
Special Accommodations:
*Tables and chairs will not be provided at this event, please plan accordingly. This is an outdoor event; it is recommended that all resource providers bring a canopy.
Hidden
Would you like to contribute a raffle prize to the event?
(Required)
Yes
No
Description and Quantity:
