Health Fair Request Form | American Behavioral

Health & Benefit Fair Request Form

A health and benefit fair is an excellent opportunity for your employees to become better informed about their benefits. Please complete and submit this form and a member of our Client Services team will plan to attend your company’s health and benefit fair. If you are hosting a fair with multiple sites, please list all locations and times under Additional Information. Please note that we request a minimum of three weeks notice when scheduling an event. This allows us to schedule an appropriate, prepared and qualified representative for your event. A confirmation e-mail and the name of the attending representative will be sent to the contact e-mail address provided below. **If a representative is not available to attend, materials can be mailed for your event.

Company Name*
Site Contact Name*
First Last
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Address where Fair will be held (If Different from physical address):
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date*
Date Format: MM slash DD slash YYYY
Start Time*

: HH

MM
End Time*

: HH

MM
Number of anticipated participants:
Additional Information: