1. Contact person for the activity:
Name*
Address*
Telephone No.*  (xxx-xxx-xxxx)
Email*
2. Purpose of the activity:*
Please indicate what you would like the Commission to do.
Offer presentation to group
Set-up information table
Provide brochures and promotional items
Other
3. When and where would you like to schedule the activity:
Date*
     
Time*    
Location*    
4. Subject to discuss:
Please indicate what you are interested in learning more about.
5. Number of people expected to attend the activity:
6. Will the participants be:*
Residential
Commercial
Both
7. Is there any other information you would like to share with us to help us ensure the outreach activity satisfies your needs?
8. Will audio and/or video equipment be available for use with the presentation?
Yes     No
  
Item marked with an * is mandatory.