Note: Press coverage opportunities are only available for oral health care educational events connected to your practice or the District and/or oral health and non-oral health related community service activities involving the District.

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1. Event Contact Information:
Who should we contact with any questions about this request? (Required.)

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2. District Name

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3. Event Name (Required.)

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4. Event Date and Time (Required.)

Date

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5. Event Start Time (Required.)

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6. Event End Time

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7. Event Location Information

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8. Event Information

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9. Publications to Send Release (up to five) (Required.)

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10. Photo (if applicable)

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11. Photo Caption (identify location and full names of those photographed)

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12. Upcoming Events

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13. Additional Comments

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