KC Pride Wellness Tent Provider

User information

• First name
• Last name
• Email
• Gender
• Birthday
• Address

Business information

• Business name
• Legal business name
• Contact name
• Address
• Email
• Phone
• Website (Optional)
• Logo (Optional)

Additional information

• Do you have the current Missouri license(s) required to provide your services in the Wellness Tent?
• Do you agree to bring your current Missouri license(s) to the Wellness tent and display it prominently while you are practicing?
• Do you agree to abide by all KCMO and Missouri rules and regulations as pertains to your area of service?
• Do you agree to provide your services to every area of the LGBTQ+ community and/or our allies without judgment or prejudice?
• Service Provider’s Name
• Legal Name (Name on Your Government-Issued ID)
• Name of all assistants (if applicable)
• Primary Contact Person Name
• Pronouns
• Street Address - 1
• Street Address - 2
• City
• State
• Zip Code
• Phone #
• Email Address
• What services do you want to provide in the Wellness Tent at Pride?
• Does the service provider(s) identify as LGBTQ+?
• Do you have any accessibility needs that you would like to share with us?
• Do you require any special equipment, accommodations and/or clearances? If yes, please provide a description and be as specific as possible.
• Years of experience in your area of practice?
• Name of business?
• Where do you currently practice? Please provide physical address(es) and website(s) if applicable.
• Are you interested in giving a Wellness-related demonstration or presentation in the Education tent? No/Yes - if yes, please describe the type of presentation you would be interested in providing.
• How many tables and chairs will you need to comfortably provide your services?
• If your services need specific items, will you be able to provide them?
• What times/dates are you interested in providing services? (Select as many as applicable)
• I agree to the terms and conditions detailed above to be considered for providing services for the 2024 Kansas City Pride Community Alliance PrideFest in the Wellness Tent.