Wellness Event Vendor Application

Health & Wellness Symposium- Vendor Application Form

Thank you for your interest in our Wellness Event, where proceeds from your sponsorship will go to support our special new PRIME program at Misericordia Health Centre.
Please fill out this form and submit below, we will then email you an invoice. Thank you for supporting healthcare in your community!

Have questions about this form or event? Call us!
Vernelle Mirosh,
Manager of Partnerships and Special Events
vmirosh@misericordia.mb.ca
(204) 788-8469

Vendor Information

* Indicates required field

Vendor/Organization Name *

Your Name *

First

Last

Email *

Phone Number *

Preferred Contact Method *

Phone Email

Address

Line 1 *

City *

Postal Code *

Line 2 *

Province *

Preferred Method of Payment *

Credit Card Cash Cheque

Additional Information *

Cost to be a vendor is $750, with all proceeds going towards the PRIME program, supporting healthy aging in our community- thank you so much for your support and participation!

Submit

Health & Wellness Symposium- Vendor Application Form

Vendor Information

Address

Mailing Address

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