Community Outreach
Name
*
First Name
Last Name
Email
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Organization
*
Name of Event
*
Event Address
*
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Date and Start Time of the Event
*
-
Month
-
Day
Year
Date Picker Icon
Hour Minutes
AM
PM
AM/PM Option
This date is flexible:
*
Yes
No
How long is your event?
*
1 hour
2 hours
3 hours
Other
Date Commitment is Needed By
*
-
Month
-
Day
Year
Date
Please describe the audience.
*
e.g. men, women, children, seniors, etc.
Number of Attendees
*
Minimum is 30
What are you requesting?
*
Include topics you would like to be covered, type of screening if desired, whether we should provide informational materials, or presenters.
Select all equipment available for our use:
*
Projector
Laptop
Screen
Microphone
Table
Chairs
Electricity
Additional Comments
Has LVHN participated in this opportunity in the past?
*
How will you promote this opportunity to potential attendees?
*
Upload any documents that would be helpful: (ie. Promotional flyer)
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