Please complete this form to request or suggest an ACFC Care Fair at your work location.

Please Note: Fields labeled in red are required.

Your Information
First Name:	Last name:

Date you are looking to schedule:

Location
Work Address:	Room/Floor:

City	State:	Zip:

Management Contact
Name:	Telephone:

Union Contact
Name:	Telephone:

ACFC Ambassador (if one has been designated)
Name:	Telephone:

Employees
Number of employees you anticipate to be available to attend:

After your request is submitted, the ACFC will review and respond to your request. If you have had a Fair previously, that may prevent another one from being scheduled.