Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Business or Organization's Name *Contact Person Name *FirstLastEmail *WebsitePhone *Social HandlesBusiness or Organization's Address *Address Line 1Address Line 2CityState / Province / RegionPostal Code— Select country —AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryDescription of Services or Information to be Provided: *Briefly describe what your booth will offer to attendees.Health and Wellness Focus : *Mental HealthReproductive HealthStress Management and Self-careNutritionFitnessAlternative MedicineOtherInteractive Elements (if any):Describe any interactive components or demonstrations you plan to include.Please confirm you will bring your own tent, table, and chairs. *Yes, I will bring my own.Do you require any special accommodations? *YesNo – Please Answer The Next QuestionNote: Electricity is NOT provided. Participants are responsible for bringing all necessary equipment, including tents, tables, and chairs.If yes, please specify:Educational Materials or Resources :List any materials you plan to distribute, such as brochures, flyers, or samples if possible.Participation Goals : *What do you hope to achieve by participating in the Health and Wellness Zone?Health + Wellness Zone Information Booth Participant Agreement By participating in this event, you agree to the following terms and conditions: Compliance: You agree to comply with all applicable city, state, and federal regulations, as well as the specific rules and guidelines established by the event organizers. Product and Content Restrictions: No products or materials deemed inappropriate, harmful, or inconsistent with the event’s goals will be permitted. The event organizers reserve the right to reject any application that violates these terms. Event Liability: You agree to hold Dr. Robyn White, DNP (DRW Health Solutions, LLC) and Pamoja Place harmless from any claims, damages, losses, or expenses arising from your participation in the event. DRW Health Solutions, LLC and Pamoja Place are not responsible for any products or services offered by participants. Event Conditions: The event will take place rain or shine. No refunds or compensation will be provided due to adverse weather conditions or other unforeseen circumstances. Setup and Breakdown: You must adhere to the designated setup and breakdown times. Early breakdown of your booth is not permitted. Please ensure your booth is fully operational during the event hours. Insurance Requirement: Participants must provide proof of insurance coverage with a minimum of $500,000. DRW Health Solutions, LLC must be listed as the primary insured, and Pamoja Place as the secondary insured. The insurance certificate must be valid for the duration of the event on Sunday, September 22, 2024. Participants are responsible for their own insurance coverage, and the event organizers are not liable for any loss, damage, or injury. Licensing and Sales Tax: Participants must be properly licensed and legally authorized to provide services or distribute information. Any applicable sales tax is the sole responsibility of the participant to manage and remit. Safety and Cleanliness: Participants are required to maintain a safe and clean booth area. All displays and materials must be securely positioned to prevent accidents. Participants are responsible for removing all trash and leaving their space clean. Conduct: All participants are expected to conduct themselves in a professional and respectful manner at all times. Harassment, discrimination, or any form of inappropriate behavior will not be tolerated and may result in immediate removal from the event without a refund. By clicking “I Understand and Agree,” you acknowledge that you have read, understood, and agree to abide by all the rules and conditions listed above. Non-compliance with these rules may result in the termination of your participation without refund. I Understand and Agree.YesNo – Don’t click submit. Stop Here.Submit