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Community Event Request
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 in Anne Arundel County in order to inform the community about important health topics. If you would like to request for the Department to participate in your event, 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 Affairs Specialist.

If you have any questions or cannot fill out the online form, call 410-222-3501.

First Name:
Your answer
Last Name:
Your answer
Phone Number:
Your answer
Email:
Your answer
Sponsoring Organization Information:
Organization Sponsoring Event:
Your answer
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
:
Event Begin Time:
Time
:
Event End Time:
Time
:
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):
Rain Date:
MM
/
DD
/
YYYY
Tables and Chairs Supplied?
Brief Description of the Event (include any website link):
Your answer
Fee to Participate?
Additional Event Notes:
Your answer
Areas of Interest:
Adult Health Services (Check all that apply.)
Behavioral Health (Check all that apply.)
Communicable Diseases & Immunizations (Check all that apply.)
Environmental Health (Check all that apply.)
Infant, Children & Adolescent Services (Check all that apply.)
Uninsured (Check all that apply.)
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