Community Organization Request Form Organizational Information Name of Organization Making Request Individual Information First Name Last Name Phone Number E-mail Address Reason for getting in touch Event Information If you are interested in scheduling a presentation or requesting informational materials please fill out the information below. Type of Event Type of Event - None -Health FairPresentation or TalkConference or WorkshopClub or Organization MeetingOther… Enter other… Location of Event Time of Event Format of Event - None -In-personVirtual Anticipated Number in Attendance Requested Items (e.g. speaker, resource table, etc.) What is the theme or purpose of the event Additional Comments