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Oklahoma City-County Health Department Community Health Engagement Event Request
Please note that filling out this form does not guarantee our participation in your event. Our Community Program Coordinator will contact you after submission.
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* Indicates required question
Name of Organization
*
Your answer
Name of Event
*
Your answer
Date of Event
*
MM
/
DD
/
YYYY
Time of Event
*
Time
:
AM
PM
Event Contact Name
*
Your answer
Event contact email
*
Your answer
Event contact phone
Your answer
Event Address
*
Your answer
Estimated Attendance
*
Choose
Less than 50
51-100
101-200
201-350
350+
Type of Event
*
Vaccine Only
Vaccine and Outreach
Community Outreach
Health Fair
Health Education
Presentation
Brief description of event
*
Your answer
Please list any additional confirmed vendors.
*
Your answer
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