* 1. Enter your Contact Information.

* 2. Name of Event.

* 3. Location Address.

* 4. Date(s) and Time(s) of Outreach Activity.

Date/Time
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:

* 5. Type of Outreach Activity Requested.

* 6. Topic.

* 7. Describe your target audience.

* 8. How many people are you expecting to attend?

* 9. You will need to provide us with a table and chair?

* 10. What size will the table be?

* 11. Will this activity be inside/outside?

* 12. What happens in the event of rain?

* 13. Are electrical outlets available for a PowerPoint Presentation?

* 14. How is this Outreach Activity being Advertised/Promoted?

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