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Provider Registration
Katie Rose
2025-03-26T21:45:30-07:00
Provider Registration
2025 Wellness Fair Registration
Step
1
of
3
33%
Tell Us About You
Name of Organization or Business
Name
(Required)
First
Last
Email Address
(Required)
Enter Email
Confirm Email
Email Permission
(Required)
Contact me only about the health fair.
Contact me about all events and programs happening at East Whatcom Regional Resource Center.
Phone Number
Organization Website
Logo File
Accepted file types: jpg, png, , Max. file size: 10 MB.
Please share an image file of your logo to be included on our website.
What You'll Provide
Services
Services
Please describe the services you plan to provide at the health fair.
Resources
Resources
Please describe the resources you plan to provide at the health fair.
Activities
Activities
Other/Not Sure
Other/Not Sure
Please describe the activities you plan to provide at the health fair.
Team and Booth Setup
How many staff members from your organization will be attending?
(Required)
Will your organization fit at a standard tabling setup (one table and two chairs)??
Yes
No
Do you require an inside space?
Yes
No, but it is preferable
No
This field is hidden when viewing the form
Do you need to reserve any of the following equipment?
Table
Chairs
I am able to provide my own equipment
Please note: we ask all providers who are able to provide their own equipment to please do so. While EWRCC is able to provide some tables and chairs, supplies are limited.
Will you need access to an electrical outlet?
Yes
No
Will you need access to the EWRRC WiFi network?
Yes
No
Please note: the EWRRC network does not meet current HIPAA compliance standards. If using EWRRC WiFi, providers must use their own VPN or other security measures.
Please describe any additional space or special setup needs:
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