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Attendee Registration
Katie Rose
2025-03-26T21:42:28-07:00
Attendee Registration
2025 Wellness Fair Registration
Step
1
of
4
25%
Tell Us About You
Name
(Required)
First
Last
Email Address
Phone Number
Phone number is required If you are interested in scheduling an appointment or would like to request Door-to-Door Transportation Assistance
ZIP Code
Enter your ZIP code
Are you interested in volunteering at the health fair?
Yes
No
Who Will Be Attending?
How many people will be attending the health fair in your party?
Please include yourself in the total.
Are there children in your group?
Yes
No
Please let us know if there are any children up to the age of 17 in your group.
How many children will be attending?
What Services Are You Interested In?
Insurance is not required to receive medical services at the health fair. Services are not guaranteed and depend upon provider availability and event capacity.
Are you interested in scheduling an appointment for services at the health fair?
Yes
No
Currently available services include: medical appointments, dental care, vision services, and Drivers Licensing Services.
Would you like to make an appointment for any of these services? (Select all that apply)
Medical Appointment
Dental Appointment
Vision Exam
Drivers Licensing Appointment
Are you interested in scheduling door-to-door transportation services?
I would like to schedule a ride.
Not at this time.
Please note that by selecting "yes" you are also giving permission for the East Whatcom Regional Resource Center permission to share your personal information with the Whatcom Transit Authority. We will only share information directly related to scheduling an appointment and will not share details about services you are scheduling.
Pick-Up Address
Street Address
Address Line 2
City
ZIP / Postal Code
Phone Number
How many people are you requesting a ride for from this address?
Do you use one of the following mobility devices?
I do not use a mobility device.
Wheelchair
Walker
Cane
Scooter
Other
Help Us Plan Future Events
What other services would you like to see offered at the Catherine Mahaffey Health Fair?
Foot Care
Dental
Sexual Health
Hearing Tests
Memory Checks
Physical Therapy
Nutritional
Chiropractic
Please indicate what other services you would like to see offered at the fair. If these services become available for the 2025 event, East Whatcom Regional Resource Staff will contact you via email.
Other (please specify):
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