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Census Speaker or Table Request
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Organization Sponsoring Event
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Contact Name
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Contact Email
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Contact Phone Number
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Name of the event :
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Event Address
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Event Start Date :
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Event Start time :
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Time
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AM
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Event End time :
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Time
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AM
PM
Please describe the Event
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How can we best support you?
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Have a table at the event
Give a short presentation (less than 5 minutes) - Census 101
Give a longer presentation (5-15 minutes) - Census 101 and County Perspective
Give workshop or Training about the Census in Contra Costa County
Other:
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Do you need additional language assistance
Yes
No
Maybe
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If so, which languages
Spanish
Tagalog
Cantonese
Mandarin
Vietnamese
Farsi
Korean
Other:
What materials would be helpful at your event?
Flyers about the Census
Swag
Other:
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