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Community Event Form

  1. TCHDclear

  2. Thank you for your interest in having Tri-County Health Department at your upcoming event. Please use this form to tell us about your event. We appreciate as much notice as possible and would prefer the request be made two weeks in advance. This will improve our ability to meet your needs; however, it does not guarantee a presenter will be available to attend your event. You will receive an email or phone call accepting or declining your invitation within 7 – 10 days of submitting this form.

  3. Contact Person Information

  4. Sponsoring Organization Information

  5. Event Information

  6. Is Your Event:

  7. Is There A Fee For Our Participation In Your Event?

  8. Would You Like:

  9. Will Attendees Be Charged For The Event?

  10. Target Audience

    (please check all that apply)

  11. Event Will Be Held

    (please check all that apply)

  12. Item Provided By Event

    (please check all that apply)

  13. Indicate Equipment Available

    please check all that apply)

  14. Please Indicate Which Topics You Are Requesting A Presenter Or Information About

    (please check all that apply)

  15. Leave This Blank:

  16. This field is not part of the form submission.