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PSC Equipment & Supplies Request Form
Please email Michael at mrobles2@uic.edu if you have any questions or don't hear back from me within 2 days
Name *
Your answer
Email *
Your answer
Event *
Your answer
Date of the Event *
MM
/
DD
/
YYYY
Which health fair supplies do you need? *
Required
Please state what quantities of the above supplies if you need more than one (i.e. how many test strips) *
Your answer
Any other concerns/questions/notes for PSC?
Your answer
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