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

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* 2. Date & time of event

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* 3. How long will the event be?

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* 4. Sponsoring Organization

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* 5. Primary Contact Name & Pronouns

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* 7. Phone Number

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* 8. Location of Event

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* 9. Brief Description of Event

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* 10. Description of Location

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

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

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* 13. Please share the anticipated number of attendees

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* 14. Is there a cost to table at this event?

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* 15. Has Mazzoni Center tabled at this event in the past?

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* 16. Are you interested in any of the following at your tabling event?

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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?

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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:

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* 20. Deadline for Mazzoni Center to respond with a decision regarding this request:

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