Tabling

PHC Tabling Application

Thank you for your interest in tabling at Partnership Health Center. Please review our Tabling Policy (this will be linked once a final version is complete) then complete and submit the online form below. A member from our team will be in touch upon review of your application.

Organization Information

* Indicates required field

Name of Organization *

Organization's Website *

Organization's Address *

Line 1

Line 2

City

State

Zip Code

Country

Contact Name *

First

Last

Title *

Phone Number *

Email *

PHC Point of Contact Information

PHC Staff Member Name *

First

Last

Title *

Phone Number *

Email *

Reason for Tabling

Please include information about how the tabling event will benefit PHC patients’ health and wellbeing and/or help address a social determinant of health.

Reason for Tabling *

What do you plan to bring?

Please list what you plan to bring to your tabling day(s) at PHC below (e.g. food, brochures, pamphlets, etc.).

What will you bring? *

Preferred Tabling Dates

Tabling must occur during PHC's standard business hours and the start date, end date, and days of the week are agreed upon at the time of this application's review. View our hours of operation here.

Please list your top 3 preferred dates and times for tabling at PHC. Final dates and times will be decided upon review of your application.

Preferred Dates & Times *

Signature

By typing my name in the box below, I agree, on behalf of myself and my organization, to the following:

My organization is a non-profit organization and will not attempt to sell or market products for profit.
My organization will not conduct fundraising activities while tabling at PHC.
My organization will abide by all PHC policies pertaining to conduct within the building, including COVID-19 safety measures.
Failure to comply with PHC policies may result in the loss of tabling privileges at PHC.
My organization is responsible for returning the used space to the original condition with the entire area clean and all trash and debris removed.
My organization is responsible for any damages resulting directly from the tabling activities.
Tabling is limited to a designated physical space within PHC.
My organization will not conduct any electioneering including by not limited to advocacy for or against any political candidate or legislation unless the legislation will directly influence PHC.
My organization will not spread misinformation or disinformation, and will not engage in intimidation of any PHC staff or patients.

Signature (please type your full name) *

Submit