Event Request Form

Please complete the following information for us to review your community health fair request.
Central Florida Black Nurses Association is composed of volunteer nurses, we will assess requests on a first come, first serve basis as our availability allows. Please submit requests at least 30 days in advance.

Name of Contact Person

Email of Contact Person

Name of Host Organization

Phone/Mobile

Event Details

Please provide details surrounding your event.

Name of Event

Start Time of Event

Number of Event Participants Expected

Date of Event

End Time of Event

Event Address

Address Line 1

City

State

Zip Code

Description of Event

CFBNA Volunteer Services Request

Blood Pressure check / consult

Body Mass Index check / consult

Presentation on Diabetes - Audio visual equipment and computer must be supplied by requester

Presentation on Cardiovascular Disease - Audiovisual equipment and computer must be supplied by requester

Other

Additional Comments

Event Request Form

Event Request Form

Event Request Form

Event Details

CFBNA

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