Name of Organization
(Required)
Contact Name
(Required)
First
Last
Contact Phone
(Required)
Contact Email
(Required)
Event Summary
(Required)
How many attendees will be at the event?
Information about the Audience/ Attendees
How would you like our office to be involved?
Training
Information Table
Presentation
Community Action Office Hours
Other
If other:
What is the topic for the event?
(e.g. what would the training be about?)
What languages will be spoken?
Will translation(s) be needed?
Event Date
MM slash DD slash YYYY
Event Time
Hours
:
Minutes
AM
PM
AM/PM
Event Location
Is this event open to media?
Yes
No
Is this event open to the public?
(Required)
Yes
No
Any other helpful information