Outreach Supplies and Event Support

Would you like to order outreach supplies or request support for an event? If so, please complete the following form.

Do you have a conference, meeting, fair, educational forum, trade show, or you just want to help spread the word about LivLyme and/or TickTracker?

We can send you a LivLyme Info Kit (LivLyme Outreach materials) or TickTracker Info Kit (a TickTracker postcard stand, TickTracker postcards, stickers and bracelets). 

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* 1. Today's Date

Date / Time

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* 2. I would like to request informational materials for

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* 3. Materials requested (if applicable check all that apply)

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* 4. Please tell us how you plan to use the materials.  Examples include office waiting room, conference outreach table, event etc.

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* 5. I would like to request someone to attend or speak at an event. Please check all that apply.

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* 6. Please describe event: Name, Purpose, Number of Attendees expected etc.

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* 7. Date of event, if applicable

Date / Time

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* 8. Date materials requested by, if applicable

Date / Time

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* 9. Contact Information

T