Event Screening Form


    Note: submission of the request is not a confirmation.

    If school, will kids come with teacher for: Set amount of timeJust "fly by"

    Topics of presentation: NutritionHygieneDiabetesTobacco

    Will it be indoors? yesno

    If not, will there be a tent provided? yesno

    Will there be tables and chairs set up? (displays need a 6’ long table each): yesno

    We would like to partner throughout the year, can we schedule one of the items below? yesno

    Check all that apply: Speaker on health topic for employee lunch ‘n learn or support groupConsultation on food available to target audience (vending areas, cafeterias, mtgs)Can we join your health team meetings?