GLACVCD Media Interview & Event Participation Request
Please complete the form below, to request the Greater Los Angeles County Vector Control District to participate in your community, organization, or partner service event.

Event requests must be submitted 14 days prior to your event date to allow adequate time for material preparation and staffing arrangements.
Sign in to Google to save your progress. Learn more
Event Name
 *
Event Type
 *
Format
 *
Location (Street Address or URL)
 *
Please include the street address of an in-person event, or the full web address of a virtual event
City
Please include the city of an in-person event
Location (Zipcode)
Please include the zipcode of an in-person event
Event Date
 *
MM
/
DD
/
YYYY
Event Start Time
 *
Time
:
Event Setup Time
 *
Time
:
Event End Time
 *
Time
:
Event Breakdown Time
 *
Time
:
Estimated Event Size
 *
GLACVCD Personnel Request (check all that apply)
GLACVCD Materials Request (check all that apply)
 *
Required
Please indicate the quantity of materials you are requesting (mosquito literature request only)
What Supplies / Equipment Are Included At Your Event? (Check All That Apply) *
Required
Event Details
 *
Please describe your event in detail, including its purpose and why the GLACVCD will be a good fit
Next
Clear form
Never submit passwords through Google Forms.
GoogleForms
This content is neither created nor endorsed by Google.