2016 CPS Week/Seat Check Saturday Event Registration Form

33% of survey complete.

Complete the following form to register your Child Passenger Safety Week community event. Registered events will be promoted and advertised through local media releases and posted on the NHTSA and PA TIPP websites. PA TIPP does not need to be involved in the community car seat check events; we are merely compiling a list of all events to share with PennDOT, NHTSA and statewide community partners. If you are interested in receiving a list of events being held throughout Pennsylvania, please email aosterhuber@paaap.org. Thank you!

Question Title

* 1. Sponsoring Organization and Contact Information

Contact Name:

Organization:

Phone:

Email:

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* 2. What is the date & time of this event?

Start Time

Date

Time

AM/PM

End Time

Date

Time

AM/PM

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* 3. Event Location

Event Location *

Address: *

City: *

State:

ZIP/Postal Code: *

County: *

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* 4. Does this event require appointments?

Appointments Required

Appointments and Walk-Ins.

Walk-Ins