Community Education Program
Please make sure to fill in everything that applies and submit with at least 3 weeks before the event. If your event is in less than 3 weeks we will work with to see if it is something we are able to attend.
Event Date *
MM
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DD
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YYYY
Agency or Community Partner *
Your answer
Event Name *
Your answer
Contact Person *
Your answer
Email *
Your answer
Phone # *
Your answer
Setup time *
Time
:
Start Time *
Time
:
Event Duration *
Hrs
:
Min
:
Sec
Expected # of Participants *
Your answer
Event location and directions (please include address and cross streets): *
Your answer
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