Outreach Event Request Form

* First Name:

* Last Name:

* Phone:

* Email:

* Event Name:

* Event Description:

* Purpose of Event:

* Event Date:

* Event Times: Start Time: End Time:

* Location Name:

* Event Location Address:

* Approximate number of attendees:

* Parking available?:  Yes  No

* Event Type: Select Community Event Public Information Education Event Chamber of Commerce Event Service Club Event Other

* Outreach Type:  Voter Education  Photo ID  Speaking Engagement  Other

   If “Other”, please enter:

   Additional Information:

* Is there a wall for a backdrop?  Yes  No

* Number of Outlets Available:

* Tables / Chairs Available?  Yes  No