Hispanic Health Professionals Association Inc NY.
Community Health Fair "Decide to be Healthy"
http://www.ahpsi.org

Registration Form•Hoja de registración•Community Health Fair.

DATE: Sunday,June, 22, 2014, Dr.Herbert Richardson School,
Address :318 Stockton St, Perth Amboy, New Jersey 08861. time: 8am-3pm.

Name: __________________________________________ Profession _____________

Phone:_______________________ e-mail:____________________________________

We welcome all Health Professionals and volunteers regardless of age or experience. Just fill out this form to tell us how you can help.

Which area(s) are you most interested in working? Please select all that apply

□ Medical Screening Glucose, Cholesterol & Blood Pressure.
□ Dental Exams • Exámenes Dentales.
□ "Ask Your Doctor", Referrals • Consulta Médica- Referimiento
□ Provide Massage • Masajes.
□ Mental Health Counseling • Consejería Psicológica.
□ Nutritional-Counseling, Diet Assessment. Consejería Nutricional.
□ Conference (Specify) ________________________________________.

□ Workshop (specify) • Taller (especifique) ________________________________.

□ Chiropractic Exam.
□ Translate, Fill up Form • Intérprete.

Basic Logistics

□ Registration Assistance, Data Entry.
□ Parking Control.
□ Directing Traffic.
□ Set-up Tables, Medical Supply.
□ Logistics Breakfast-Coffee Break -Lunch.
□ Set up, Sign-Banner -Materials, Boxes • Letreros.
□ Accommodating the Public Attendees- Descongestionamiento de filas, estableciendo orden.
□ Gift Certificate Raffles •Rifas-Logistics.
□ Help Privacy area, Papanicolau, Prostate.
□ Help entertainment Audio, Music, Clowns • Payasos.
□ Fill out Form Community Health Survey • Llenar Encuesta de Salud.
□ Other • Otra manera de ayudar (Specify): ___________________________________

Dr. Aritmedes Restituyo, Coordinator: 732-277-9640, 917-403-9220.
info@ahpsi.org

Formulario, registracion voluntarios a nuestra feria de salud, Please copiar & Enviar por correo electronico:info@ahpsi.org Thanks.