Team Upstate

Health Fair Request Application

Those requesting participation by Upstate Medical University in a health fair or similar gathering, please complete the following at least 3 months in advance of your event. We will review your request and contact you shortly after its submission.

* Indicates a required field.

* Name of your organization

* Your name

* Your email

* Your phone number(s)

* Please describe your event and explain how you would like Upstate Medical University to participate

* What is the date, time and location of this event?

* Is this a first time or annual event?

* What is the expected attendance?

* Who is the targeted audience? (families, youth, minority groups, for example)

* How will Upstate Medical University be acknowledged?

* Please describe any costs that will be associated with this fair/event (displays, power, internet, parking, etc.)

* Please describe what will be available (tables, chairs, power, internet, parking, etc.)

* What are the dimensions of space allowed for displays?

* What are the setup and take down times?

* How many exhibitors do you expect?

* Will there be other Health Care providers or facilities present?

Have you contacted other Upstate Medical University department representatives? If so, who?

Additional comments