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/ Mobile between 8am and 9am) Agency/Organization/Individual Name: Contact Person: Title: Phone Number: Fax: Email Address: Mailing Address: City State Zip code Agency description/services provided: Will participate in the following way: (Check all that apply) Distribute Literature, Handouts Offer Free Mammograms Provide Outreach During The Event Offer Voter s Registration Offer Career/ Educational Services Distribute Male/Female Condoms Distribute Safe Sex Kits Offer Free Diabetes.

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Keywords relevant to Health Fair Screening Form

  • 9am
  • 573-DRUG
  • 78TH
  • ext
  • screenings
  • Estrada
  • EXPO
  • outreach
  • Handouts
  • prevention
  • KITS
  • coordinated
  • Mailing
  • Fest
  • distribute
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