CEMA Outreach Event Request Form

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1. To request an event outreach from CEMA for your organization, please fill out the form below.
2. ATTENTION! If you need confirmation before three (3) business days, please complete this form and call the office at 912-201-4500.
3.If you need to cancel your request, please do so within 24 h of the requested date.

Email *

Disclaimer

If you are requesting an event outside of regular business hours, after 5 PM or during the weekends, there must be at least 10 confirmed participants.

Organization Name *

Point of Contact: First Name and Last Name *

Will above point of contact be on site? *

Yes

If you selected no, please list who will be available. If you selected yes, please select not applicable *

Not applicable

Other:

Phone Number *

Email Address *

Requested Date and Time: *

Weekend and evening requests must have a minimum of 10 confirmed participants

YYYY

Time

Audiences *

Children, Ages 5-10

Youth, Ages 11-17

Adults, Ages 18-21

Adults, Ages 21+

Seniors, 55+

Adminstrators

Government Officials, Community Leaders, etc.

Other:

Required

Number of Attendees *

Weekend of evening events must have at least 10 confirmed participants

10-25

25-50

50-75

75-100

100+

Event: Describe the purpose of your event *

Event Address: street address, zip code, suite number, etc. *

Is on-site parking available? *

Yes

Is this event inside or outside? *

Inside

Outside

Required

Will your organization provide tables? *

Yes

If yes, what size? *

6 ft

8 ft

Not Applicable (if you answered no.)

Will your organization provide a tent or shelter if the event is outside? *

Yes

Not applicable

Other:

A copy of your responses will be emailed to the address you provided.

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