Thank you for your interest in having Mazzoni Center attend your tabling event! This form must be filled out at least 2 weeks in advance of the event order to best fulfill the request. If you'd like onsite HIV testing, please fill this form out 3 weeks in advance. Once you submit your request, a team member will reach out within 2 business days.

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1. Name of event (Required.)

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2. Date & time of event (Required.)

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Time

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3. How long will the event be? (Required.)

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4. Sponsoring Organization (Required.)

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5. Primary Contact Name & Pronouns (Required.)

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7. Phone Number (Required.)

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8. Location of Event (Required.)

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9. Brief Description of Event (Required.)

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10. Description of Location (Required.)

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11. The following will be provided by the hosting organization (please mark all that apply): (Required.)

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12. Ages of attendees (choose all that apply) (Required.)

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13. Please share the anticipated number of attendees (Required.)

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14. Is there a cost to table at this event? (Required.)

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15. Has Mazzoni Center tabled at this event in the past? (Required.)

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16. Are you interested in any of the following at your tabling event? (Required.)

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17. Is it appropriate for Mazzoni Center to display and distribute sexual health related items (such as condoms) while tabling at this event? (Required.)

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18. If known, what other organizations will be tabling?

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19. Please tell us anything else you believe it is important for us to know about this request: (Required.)

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20. Deadline for Mazzoni Center to respond with a decision regarding this request: (Required.)

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