CENTRAL FLORIDA BLACK NURSES
COMMUNITY HEALTH FAIR FORM
WE ARE A NON- PROFIT ORGANIZATION
Dear Community Agency, please print and fill out this form and mail to the address below if you are requesting
our services.
Name of Agency ____________________________________________
Contact Person/Telephone # ___________________________________
Name of Event ______________________________________________
Location ________________________________ Time______________Date _________________
Number of Participants expected ____________
Screening required __________________________________________
Our organization consists of nurses who are qualified to perform the following tests; blood pressure, blood
glucose, cholesterol and body mass index.
We asked that you send in your request at least one (1) month prior to the date of your health fair.
If our services are needed for your Health Fair, we asked that you supply the following necessary supplies:
Bayer Contour strips; Accucheck Cholesterol strips.
All other materials will be supplied by the CFBNA.
Send request to: CFBNA, P. O. Box 585142, Orlando, FL, 32818
