Vendor Form

LIVE HEALTHY CAMPAIGN BLOCK PARTY
AUGUST 15, 2009
Click here for a print version of this form.

Business Name
Contact Name
Mailing Address
City
State
Zip
Phone
Fax
E-mail
FINANCIAL SPONSORSHIP (please make check in the appropriate amount):
LIVE HEALTHY NON-PROFIT ORGANIZATION (non-sales): $150.00 You receive 1 6 foot table-2 chairs inside tent
BE HEALTHY SERVICE/PRODUCT VENDOR: $500.00 You receive 1-6 foot table-2 chairs inside tent to sell your service and or product
GET HEALTHY FOOD VENDOR: $650.00 All setup and equipment used must to be approved by CAHN prior to Health Fair. Food Vendor responsible for having food handler/Health Department Documentation on-hand prior to Health Fair (Certain restrictions apply)
OTHER (Donation non-participant)                      Amount
Promotional Dates:   Website Dates- TBA Outdoor Promotional Dates-    TBA Advertising Dates-  TBA Email Blast Dates- TBA Poster/Flyer Campaign Date-     TBA

If you have any questions, please don’t hesitate to contact Monica Robinson at
(804) 525-1854 or mrobinson@cahealthnet.org.