Kidney Awareness Health & Resource Fair – Southeast MS Rural Health

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.
Vendor/Participant Agreement*
As a vendor/participant, I understand that I MUST provide a raffle/door prize and bring my own table, chairs, tents, power source, etc. to this event.

Contact Information