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Ryan White Program

Hattiesburg Pharmacy Assistance Center

Pharmacy Assistance Center

Prescription Assistance Program

About Us

Patient Resources

Hispanic Community Health & Resource Fair

Contact Information
Organization/Business Name:
Address:
Street Address City State ZIP Code
Contact Person:
First Last
Phone:
Email:
Service Description
Briefly describe your booth/display:
What service(s) do you plan to provide at the event?
- Activity/Demonstration
- Awareness/Information
- Other
If you selected "other" please explain below.
Please upload your business logo - if applicable.
Acceptable files include jpg, gif, png, and pdf. Max 25MB
Raffle/Door prize donation(s) must be presented to the host(s) at the of arrival to event.
Facility/Event Location Logistics
All vendors/participants must provide your own table, chairs, tents, power source, etc.

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Contact Information

Service Description

Facility/Event Location Logistics