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  • Community Outreach Event Request

    Flyers

    Send flyers of your event or any attachments to hdcommunicate@pima.gov

    Questions?

    Please contact us at
    520-724-7770 or email us at hdcommunicate@pima.gov.

    Thank you for considering the Pima County Health Department as a partner for your community event.

    Requests can include Health Department participation in community events, presentations or speakers for a specific topic.

    Guidelines:
    • All organizations must complete the Community Outreach Event Request Form below.
    • Requests must be submitted at least four (4) weeks prior to the event. Requests within a shorter time frame will be accommodated if possible.
    • If your event is later in the year, please return to complete the form closer to the event date.
    Once your event form is submitted, you will be contacted to confirm availability for your request or for clarifying questions about your request.


    Event Request Form

    Event Information

    Name of Event: *    Date of Event: *  

    Start Time: *     AM  PM  /  End Time: *     AM  PM

    Set-up Time: *     AM  PM

    Address/Location: *    City: *  

      Zip code: *  

    Indoor or Outdoor event   - If outdoor, is personal tent(s) needed?:   Yes   No

    Type of event: Community Worksite Youth Other

    Focus/Purpose of event: *  

    What are you requesting: *   Staff to table an event? Speaker?  Handouts?

    Fee to participate?:   No   Yes  

    Expected Participant Demographic

    Expected number of participants: 

    How are you advertising this event?: *  

    Target Audience Age Range:    0-5    6-17    18-30    31-50    51+  

    Spanish speaker and/or materials needed?:   Yes   No

    Special interests or requests?:


    Logistics

    What equipment or supplies will be provided?: *
     Not neededRequester will providePresenter should bring
    Electricity
    Laptop
    Projector
    Table
    Chairs

    Other agencies or partners participating:

    Special instructions:


    Requester Information

    First Name: *    Last Name: *  

    Date of Request:   

    Phone: *   

    Email: *  

    Name of Organization:   

    Organization type: Government  Non-Profit  Business  Faith-based  School
    Healthcare  Other  If other please elaborate:

    Day of Event Contact

    Contact Name: *  

    Phone: *  

     

    Referred from Page: 



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    Health Department

    3950 S. Country Club Road
    Ste. 100
    Tucson, AZ 85714

    (520) 724-7770

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