Healthy Columbus comes to YOU

Please complete this form in its entirety. Please submit requests a minimum of 4 weeks prior to the event. All services are subject to the approval by the Healthy Columbus staff. 

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* 1. What services are you requesting? Check all that apply.

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* 2. If applicable, please provide further detail about the option/s you selected above.

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* 3. What is the preferred first choice date/time of the event?

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* 4. What is the second choice date/time of the event?

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* 5. How many people do you expect in attendance?

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* 6. What is the expected duration of the activity you're asking for?

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* 7. What is your contact information?

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