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Education Program/Health Fair Request Form

  1. Montgomery County Department of Health and Human Services - Office of Community Information and Education
    Education Program/Health Fair Request Form
  2. Please check one:
  3. Expected Program Date/Time
  4. If scheduled event, program date/time:
  5. Program Topic (Please select all that apply)
  6. Grade/Age Range of Audience:
  7. Montgomery County Office of Public Health participation is dependent on several factors including staff availability, material supply, and other program/grant requirements.
  8. This project is funded by the Pa. Department of Health's Preventive Health and Health Services Block Grant.
  9. Leave This Blank:

  10. This field is not part of the form submission.