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* 1. Your Name

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* 2. Your Phone Number

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* 3. Your email

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* 4. What type are you attending?

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* 5. When is the event being held?

Date
Time

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* 6. Where is the event being held?

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* 7. Who is the main contact for the organization or school? (Name, number and email if available)

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* 8. What is the age range and/or demographics of the attendees? (Check all that apply)

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* 9. Are there any other attendee demographics you can share?

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* 10. Are you (or the person attending the event) giving a presentation?

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* 11. Is there an opportunity and space available for an informational table or exhibit booth?

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* 12. How many people will be involved in the presentation and/or exhibit booth?

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* 13. Do you need any volunteers from NYSAPLS to assist?

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* 14. Do you need any supplies or set-up equipment from NYSAPLS?

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* 15. Are you planning on bringing any survey equipment to demo? (If yes, please list. If no, let us know if you need assistance from NYSAPLS in this area.)

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