2. Health Fair Vendor Registration Form

   Application Deadline:  Friday, July 15, 2022- or until full

   SPACE IS LIMITED!

   All applications are subject to approval!

   LOCATION: Civic Center, 41000 Main Street, Temecula, CA 92590             

   DATE: Saturday, September  24, 2022

   TIME: 9:00 am - 2:00 pm

   REGISTRATION: $25.00/non-profit business (no exceptions) $50.00/for-profit business

   FEE INCLUDES: 1 canopy, 6’ table, 2 chairs, and 2 lunches

   For questions, please contact Human Services Division at (951) 694-6464

   
   

4. Company/Organization
6. Name
7. Email Address
9. Address
11. City
12. State
13. Zip Code
15. Phone Number
16. Vendor Category
    -- Select One --Health & WellnessSafetySpecial NeedsOther
18. Health Screening

    1. Yes
    2. No
19. Description of health & wellness product, screening or service:

21. Vendors providing a health screening must provide proof of insurance (see attached sample).  The Certificate of Liability Insurance from your business must be submitted along with your Vendor Application & Fee(s).

23. Lunch
    -- Select One --12
24. Table Linen
    -- Select One --YesNo
25. Do you require an electrical outlet?
    -- Select One --YesNo

27. By selecting "I AGREE" below I realize every precaution is taken to eliminate any injuries or hazards and that a competent supervisor is present; however, in the event of injury, I hereby waive, release, and hold harmless from any liability for damages for personal injury including accidental death, as well as from claims for property damage which may arise in connection with the above-named activity, against the supervisor, the City of Temecula, its officers, employees, and volunteers.  I further permit the use of activity/event photography and or video for media promotion.

    In case of accident or other emergency, personnel of the Community Services Dept. and/or its agents are hereby authorized to secure medical care deemed necessary as results of accident or injury for the participant.  I further agree to pay any and all cost incurred as results of said treatment. 

29. Liability Waiver*
    -- Select One --I Agree

31. Vendor Applications are subject to approval.

Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field