Thank you for your interest in scheduling the Arkansas Minority Health Commission's Mobile Health Unit for your community event. To help assess your needs and the Unit's availability, please complete the request form below. 
 
If questions arise, please give us a call at 501.686.2720.

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* 1. Host Organization Name:

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* 2. What is your FIRST name?

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* 3. What is your LAST name?

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* 4. What is your telephone number? please include area code

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* 5. What is your email address?

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* 6. What is the address of the event?

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* 7. Event Name:

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* 8. Brief Event Description:

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* 9. Date of Event:

Date

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* 10. Start Time:

Time

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* 11. End Time:

Time

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* 12. Will this event be held inside?

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