2. Health Fair Vendor Registration Form

   Application Deadline:  Friday, July 14, 2023 - or until full

   SPACE IS LIMITED!

   All vendor applications are subject to approval. Due to space limitations, we will not be accepting duplicate services. We are not accepting food vendors for this event.

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

   DATE: Saturday, September 30, 2023

   TIME: 9:00 am - 12:00 pm

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

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

   *Table linens and electrical outlets will not be available. It is the responsibility of the vendor to provide their own table linen. If you are interested in providing a free health screening please indicate the type of screening in the notes section of the form. 

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

   
   

4. Company/Organization *
6. Contact 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. Description of health & wellness product, screening or service:*
19. Health Screening*

    1. Yes
    2. No

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

23. Lunch*
    -- Select One --12More than 2

    Additional lunches are $5.00 each

25. 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. 

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

29. Vendor Applications are subject to approval.

Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field