Sponsor Organization

Contact Name

Phone Number

Email Address

Event Name

Event Date

Event Location/Address

Event Start Time

Event End Time

What is the purpose of this event?

Who is the intended audience for this event?

What would you like public health to do at this event?

Anticipated Attendance

Anticipated number of vendors

Is this event open to the public?

• Yes
• No

Is the event inside?

• Yes
• No

If outside, is shelter provided?

• Yes
• No

Table and Chairs Provided?

• Yes
• No

Is there anything else about this event you would like to add?

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