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Community Health Fair or Event Participation Request

Thank you for your interest in Prince George's County Health Department services and programs.

Please note that all requests received at least 30 calendar days prior to the event start date will be considered after the electronic request form is submitted. All responses will be based on the availability of staff and resources.

An e-mail confirmation of form submission will be sent to the listed e-mail address after the “Send” button is clicked. Please note that submission of this request does not guarantee Health Department participation. A staff person will contact you to confirm Health Department participation in the event.


All fields marked with * are required.

General Information
Sponsor Name:
Event Name:*
Event Contact Person:*
Contact Phone Number:* (ex. 000-000-0000)
Contact E-Mail Address:*
Event Location/Address:

Event Dates and Time
Day 1
Date:* (ex. MM/DD/YYYY)
Event Starts at:* (ex. HH:MM / AM or PM)
Event Ends at:* (ex. HH:MM / AM or PM)

Day 2
Date: (ex. MM/DD/YYYY)
Event Starts at: (ex. HH:MM / AM or PM)
Event Ends at: (ex. HH:MM / AM or PM)
Cancer (Breast, Cervical or Colon) Cardiovascular (Heart) Disease Diabetes/High Blood Sugar Health Insurance for Pregnant Women and Children (MCHP) Lead Testing (Environmental and in Children) Mental Health Nutrition/Eating Healthy Obesity Osteoporosis Physical Activity, Exercise and Healthy Lifestyles Prenatal Care Public Health Emergency Preparedness Sexually Transmitted Diseases (STDs ) and HIV/AIDS WIC Foods for Women, Infants and Children Substance Abuse (Alcohol, Drugs and Other Addictive Substances) General Health Department Services Available to County Residents Other (Specify):
Please provide all information possible

Audience (who will attend your event; for example, teens or families with children, etc.)
Is the event indoors, outdoors or both?			Indoors Outdoors Both
Approximate number of persons anticipated to attend event.

Are tables and chairs provided?			Yes No

If the Health Department is unable to participate in your event, would you like to pick up educational materials from the Headquarters Building, 1701 McCormick Drive, Largo MD 20774?			Yes No

Are there any exhibitor fees?			Yes No
	If so, what is the fee?	Fee: $

Would you be interested in having the American Red Cross attend your event to co-sponsor a blood drive?			Yes No

Community Health Fair or Event Participation Request

General Information

Event Dates and Time

Please provide all information possible