(Please complete this form)

Bethel Haitian Baptist Church (BHBC)

(Hispanic Health Professionals (AHPSI)
(United Citizens For Progress (UCP)

First Annual Community Health Fair in East Orange, NJ

Première Foire Santé Communautaire/Primera Feria de Salud Comunitaria, East Orange, NJ
Contact: Dr. Jean G. Bissainthe 862-237-4631/ Mrs. Maguy Noel 973-866-9838.
Dr. Arítmedes Restituyo 732-277-9640/ Mr. Juan Arias 908-906-3640).

http://www.ahpsi.org

Date: Saturday December 7, 2013, Time 9:00 am to 2:30 pm

(Please complete this form)

Name__________________________________________

Direction______________________________________

E-Mail_________________________________________

Make a cross to precise reasons of attendance

— Health Related services
— Mini-Conference
— Workshops
— Cultural entertainment & activities

(Remarks)

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Personal or institutional name ————————————————————————–

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Address & Phone/Email ———————————————————————————————————-

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please Fex : 732-725-0868. info@ahpsi.org