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Name of organization or church
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Name of person submitting request
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Phone number
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Email address
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Event name
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Event date & time
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Event location
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Number of attendees expected
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Is the event in-person or virtual?
in-person
virtual
If in-person, are table/chairs provided?
Yes
No
If so, what length is the table?
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Is the event indoors or outdoors?
If outdoors, do you provide a tent?
Yes
No
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Please indicate below any services you want to request for your event.
Education and Information:
Alzheimer’s Research & Memory Assessment Info
Bariatric Weight-loss Services
Cancer Information
Cardiac Health
COVID-19 & vaccine education
Dealing with Serious Illness & End of Life Care
Diabetes & Nutrition
Drug Overdose Reversal Training
Durable Medical Equipment Information
Faith & Diversity
Fall Prevention
Hands-Only CPR Training (2-minute training)
Health insurance
HIV Prevention & Maintenance
Hospital Safety for Inpatients – What to Expect
Infection Prevention & Sepsis Recognition
Medical Financial Counseling
Medication Safety
Men’s Health
Mental Health
Orthopedics & Pain Management
Spirituality & Health
Stroke Prevention & Education
Women’s Health
If you are requesting cancer information, please specify type of cancer.
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