To request participation and sponsorship for community events, please complete this form, and someone from the Office of Equity, Diversity and Inclusion will reach out to you. Contact Information Name Company Email Phone Check the type of participation you are requesting Event sponsorship Health fair participation Special event speaker Information and promotional items Health DEPOT event All of the above Level of financial or in-kind contribution requested: Event Details Event Name Event Date Event Date: Date Event Date: Time Is this a virtual event? - Select -YesNo If you answer no, please complete the event location section. Location Event Location Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Requested Deadline When do you need to know if we can help by? Attach any background materials and information One file only.256 MB limit.Allowed types: gif, jpg, jpeg, png, bmp, txt, rtf, html, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, zip.
