Community Event Request
* Required
Thank you for your interest in partnering with the Anne Arundel County Department of Health for your upcoming event. We offer our display resources to public events, such as health fairs, in Anne Arundel County in order to inform the community about important health topics. To request that the Department participate in your event or provide materials, please complete the event request form at least two weeks prior to the event.
All requests are reviewed once received. Our ability to honor your request is based on staffing and date. The form is a notification to the Public Affairs Specialist and not a confirmation that the Department will participate. Depending on those items, we may be able to provide staff and materials or just materials. If we only are able to provide materials, you may have to coordinate a pick-up date and time with the Public Information Office.
If you have any questions or cannot fill out the online form, call 410-222-3501 or 410-222-4508.
First Name:
*
Your answer
Last Name:
*
Your answer
Phone Number:
*
Your answer
Email:
*
Your answer
Sponsoring Organization Information:
Organization Sponsoring Event:
*
Your answer
Type of Sponsor
Business
Community Group
Faith-based
Government
Hospital
Nonprofit Organization
School
Other:
Event Name:
Your answer
Event Location:
Your answer
Street Address:
Your answer
City:
Your answer
ZIP Code:
Your answer
Event Date:
*
MM
/
DD
/
YYYY
Response Deadline:
MM
/
DD
/
YYYY
Event Set-up Time:
Time
:
AM
PM
Event Begin Time:
Time
:
AM
PM
Event End Time:
Time
:
AM
PM
Number of Attendees Expected:
Your answer
How many years have you held the event?
Your answer
Audience Description (County residents, age range, special interests, language, etc.):
Your answer
The event will be held (check all that apply):
Indoors
Outdoors
Rain
Rain Date:
MM
/
DD
/
YYYY
Tables and Chairs Supplied?
Yes
No
Clear selection
Brief Description of the Event (include any website link):
Your answer
Fee to Participate?
Yes
No
Clear selection
Is event in a smoke-free and vape-free environment?
*
Yes
No
Additional Event Notes:
Your answer
Areas of Interest:
Behavioral Health (Check all that apply.)
Adult Substance Misuse Treatment and Recovery
Child Adolescent and Family Mental Health and Substance Misuse Services
Substance Misuse Prevention and Education
Diseases and Immunizations (Check all that apply.)
Bioterrorism
Cancer Prevention
Emergency Preparedness
Hand Washing
Heart Health
HIV/AIDS Services
Immunizations
Infectious Diseases
Influenza/”Flu”
Tuberculosis Services
Sexually Transmitted Diseases (Infections)
Environmental Health (Check all that apply.)
Bay Restoration Fund
Food Safety
Housing and Property Maintenance
Raccoon Oral Rabies Vaccination Project
Recreational Water Quality
Wells and Septic Systems
Infant, Children and Adolescent Services (Check all that apply.)
Babies and Toddlers Health
Behavioral Health (Mental Health and Substance Use)
Dental Health
Healthy Eating and Physical Activity
Immunizations
Lead Poisoning Prevention
Medical Assistance
Parenting
Sun Safety
Teen Health
Tobacco Use Prevention
Women, Infant and Children (WIC) Nutrition
Uninsured or Low-Cost Health Care (Check all that apply.)
Adults
Families
Dental Health
Low-Cost Medical Resources
Prescription Savings Program
Transportation and Other Resources
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