Women and Families Resource Fair Provider RegistrationDue to limited space we may not be able to accommodate every organization wanting to participate in the Fair. WRF Provider Registration Form Group / Organization Name * (include middle name or initials if used) Address * City * State * Zip * Phone Number * Contact Person * Email Address * Please select the category that most accurately describes the services you wish to provide at the Fair: * Medical Services Social Services Other By checking this box I acknowledge that in order to complete registration I may be required to provide proof of insurance, including adding SDVLP as an Additional Insured, by no later than March 10, 2017. * I understand. Is your organization new to the Fair this year? * Yes No Are you interested in giving a presentation or seminar at the Fair? * Yes No (If you're not sure, check "yes" and a Fair Taskforce member will reach out to you with more information) Please tell us more about the services that you can provide at the Fair: Notes / Comments: * (is there anything else you'd like to tell us?) Please DO NOT email me notifications of SDVLP events. Please DO NOT email me notifications of SDVLP events.