Women and Families Resource Fair Provider RegistrationIf you have trouble registering, please email email@example.com. Due 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 09, 2018. Proof of insurance is only required for medical providers providing day-of medical services. * 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.