MLK FAMILY CLINIC VENDOR PARTICIPATION FORM

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FAMILY CLINIC VENDOR PARTICIPATION FORM}

Questions Email Us At info@mlkfamilyclinic.org

If you are interested in being an event CORPORATE Sponsor, PLEASE let us know!

MLK Clinic Event Your Organization Requests To Attend. (Select One Below)


Save A Life, Save A Heritage (January)
National Women’s Health Week (May)
National Men’s Health Week (June)
National Health Center Week (August)
Take A Loved One To The Doctor (September)
Harambee (October)

Organization Name
Contact Name
Phone Number
Fax Number
Email Address
Address
City, St, Zip
Services or Information Provided

Type of Items To Be Sold
Booth Fee (1 Table, 2 Chairs)	Non-profit: $30 or $30 gift
	For-profit: $100 or
	Selling food: $200 (additional paperwork will be provided to you).
No. of Outlets Needed (Please bring extension cord)
Names of Participants at Table
Will your organization bring its own table covering?	Yes	No