Nassau County COMEINUNITY HEALTH FAIR

Company/Agency Name	*
First Name	*
Last Name	*
Address	*
City	*
Zip	*
Phone/Cell#	*	(Ex. 1234567890 or 123-456-7890)
Fax		(Ex. 1234567890 or 123-456-7890)
Email	*
Type of Service you will provide (i.e. screening, testings, etc)
Giveaways
Any additional requirements or equipment for your set up must be approved before day of event
Please list the items you will provide for your setup		(Ex. Tents, Displays, Generators, Edible Items, Vans, Trucks, Etc.)
The organizers of this event are not responsible for any damaged, lost or stolen items/property PLEASE TAKE NOTICE: The following items are strictly prohibited at any County Events and may not be sold, offered for sale, exchanged or given away: any goods, services or content that violates the law or legal rights of others, weapons, including firearms, ammunition, explosives and dangerous instruments of any kind, toxic or hazardous materials, alcohol, illegal or controlled substances, indecent materials, pets or animals of any kind. The organizers of the event reserve the right to refuse or remove any items, by the proper authority that do not adhere to the foregoing restrictions. SELLING OF ANY GOODS & SERVICES IS PROHIBITED *Indicates required fields