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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 Health Department participation is dependent on several factors including staff availability, material supply, and other program/grant requirements.

  8. This project was 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.