Event Booth Registration - Health Plan of San Joaquin

Back to Care Event Registration

BOOTH REGISTRATION FORM

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**RSVP Deadlines**
Event Date	---------------	RSVP Date
Tracy Juneteenth (June 10th)	-----------------	May 31, 2023
Stockton Juneteenth (June 17th)	-----------------	June 7, 2023
Lathrop Juneteenth (June 24th)	-----------------	June 14, 2023

Back to Care EventsSelect the events you will participate in

Juneteenth (Tracy) Juneteenth (Stockton) Juneteenth (Lathrop)

Health Fair Participant TypePlease indicate you participation request

Regular ParticipantMedical Participant

** Medical participants please provide a list of services (i.e preventive care check-ups, blood pressure checks, A1c test, immunization, etc. ) you will be providing at your booth.

Medical ParticipantParticipate in Backpack Drive

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** All organizations are REQUIRED to have an interactive activity or provide health information to engage families at their booth! Please describe below what you will have available. This information will be shared in our marketing materials and media.

Regular Participant

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Medical Participants: Are You Interested in HPSJ's Back to Care Backpack Initiative?

HPSJ has a limited supply of backpacks available to support you in engaging your school-aged patients to complete visits. HPSJ will distribute backpacks to participating provider offices. If you are unable to store/inventory the supply, you can receive a voucher to pass along to your HPSJ patients. The voucher is good for one backpack and can be picked up at several events/locations.

* Would you like to participate in HPSJ's Back to Care Backpack Initiative?Click here to indicate your interest. If you would like to participate, we will contact you with more information.

YesNo

Please fill out your contact information below.

First Name

Last Name

OrganizationYour Organization

Contact Person

Address

Citycity

Zipzip

Phone Numberphone

Emaila valid email

The RSVP deadline has ended.

For questions, contact our Outreach Team at marketingevents@hpsj.com