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Health Fair & Workshop Requests

   

Interested in Having the American Diabetes Association at Your Upcoming Event?

The American Diabetes Association New York City office is happy to work with local organizations to host health fair representatives and speakers.

Please fill out the form below and fax it to 212-725-8916 if you are interested. We look forward to hearing from you!

 

Request for Health Fair Representative or Speaker Form

Name of Organization:
Contact Name:
Brief Description of Organization:
Address:
City:
State:
Zip Code:
Phone:
Fax:
Email Address:

Audience Information
Anticipated Event Size:
Event Age Range:
Language(s) Spoken by Audience:
Is the audience familiar with diabetes?
Other Information:

Location Information
Event Location:
Date of Event:
Start/End Times of Meeting or Fair:

*FOR SPEAKER REQUESTS ONLY
Start/End Times for Speaker Presentations:
Presentation Topic:
Is this workshop open to the public?
   
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American Diabetes Association • 1701 North Beauregard Street • Alexandria, VA 22311 • 1-800-DIABETES (800-342-2383)

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