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Health Fair Request Application

If you would like to request the participation of Crouse Hospital in a health fair or other similar community event, please submit your request at least two months in advance of the date of the event. We will review your request and contact you soon after its submission. Thank you for including Crouse Hospital in your plans.

Contact Information
Leesa Kelley, Community Health Outreach Manager

Health Fair Request
* = Required

* Your Organization
* Your Name
* Your Email
* Your Phone Number(s)
* Please describe your event and explain how you would like Crouse Hospital to participate

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

What is the deadline for a commitment for participation?

* 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 Crouse Hospital 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 healthcare providers or facilities present? If so, which ones?

Have you contacted other Crouse Hospital department representatives? If so, who?

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