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2. What is the name of your event?
4. What organization(s) is hosting the event?
6. Date of event
7. Time of event
8. Set-up time

   When should Health Department staff arrive to set up?

9. Length of event

   How long would you want Health Department staff there?

11. Location
    Please specify the address
12. Point of contact

    Name and phone number of the person we should contact about this event. This should be someone who can be reached day-of, as well.

13. Email address
14. Expected attendance
16. Who is your target audience?
    Include target age group and other relevant info (e.g. Parents of infants and young children in North Snohomish County)
18. Is there a specific topic you are focused on for this event?
20. Why do you think the Snohomish County Health Department would be a good addition to this event?
22. Do you already have a contact at the Health Department for this event?

    1. Yes
    2. No
23. Name of Health Department employee
25. Is this an outdoor or indoor event?

    1. Outdoor
    2. Indoor
26. Is a booth or table provided?

    1. Yes
    2. No
27. Is a canopy provided?

    1. Yes
    2. No
29. Is this a new event?

    1. Yes
    2. No
30. Has the County Health Department previously participated in this event?

    1. Yes
    2. No
    3. Uncertain
31. When did the Health Department last participate in this event?
33. Is there an exhibitor fee or sponsorship request?

    1. Yes
    2. No
34. How much is the exhibitor fee or sponsorship request?
36. Other information
    Please provide any additional information, including specific materials or supplies that may be needed.
38. What is the deadline for us to respond to this request?
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field