Application
Medical Services Registration
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Deadline: Jun 10, 2025 11:59 pm (GMT-05:00) Eastern Time (US & Canada)
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Date: Jun 28, 2025 12:00 pm - Jun 28, 2025 6:00 pm (EST)
place
New York, New York
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$500.00 - $1,000.00
About the application
About the event
Prices
| $500/package - 10ft x 20ft Space Only (Deadline: June 10, 2025) | $500.00 | Non-refundable | $500/package - 10ft x 20ft Space Only (Deadline: June 10, 2025) -One (1) 10ft x 20ft space -Two (2) Tables Four (4) Folding Chairs *If you need additional (non vehicle) space, please contact us. |
| $1000 with Testing Vehicle (includes one (1) 10ft x 20ft space) (Deadline: May 31st) | $1,000.00 | Non-refundable | $1000 with Testing Vehicle (includes one (1) 10ft x 20ft space) (Deadline: June 10, 2025) -One (1) 10ft x 20ft space -Two (2) Tables -Four (4) Folding Chairs -Vehicle Space *If you need additional (non vehicle) space, please contact us. |
Questions on the application
Business information
- Business name
- Legal business name
- Contact name
- Address
- Phone
- Website (Optional)
- Logo (Optional)
Additional information
- Company/Organization Type
- Organization/Company EIN/Tax ID Number (enter WITHOUT the dash (-) )
- What general items will you have on your table? (Info will be used in our marketing and promotion.)
- Desired Medical Services Environment
- Medical Vehicle Length in Feet
- Medical Services/Testing/Vaccination to be provided [select all that apply]
- Other Medical Services/Testing/Vaccination to be provided details:
- Facebook Handle
- Instagram Handle
- Day of Event Contact First Name
- Day of Event Contact Last Name
- Day of Event Contact Title/Position
- Day of Event Contact Work Email
- Day of Event Contact Work Phone
- Day of Event Contact Mobile Phone
- First Name of Person Who Will Complete the Medical Services Report Form
- Last Name of Person Who Will Complete the Medical Services Report Form
- Title/Position of Person Who Will Complete the Medical Services Report Form
- Work Email of Person Who Will Complete the Medical Services Report Form
- Work Phone of Person Who Will Complete the Medical Services Report Form
- Signature of Person Completing Application
Picture requirements
- Minimum pictures required: 0
Medical Services Registration
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