Event Request

Name of Individual Attending & Department*
First Last Job Title/Department
Email*
Event Name*
Event Location*
Date of Event*
MM slash DD slash YYYY
Date Requested to Pickup Supplies*
MM slash DD slash YYYY
Supplies Needed*
- Six Foot Table
- 12 Foot Pop Up Canopy/Tent
- Pull Up Floor Banner (8'x3')
- Pull Up Tabletop Banner (2.5'x3')
- Spinning Wheel
Event Details*
Size of Table Provided # of Attendees Audience (general public, professionals, employment, etc.)
Is the Event Indoor or Outdoor?*
Notes
Please list any other important information about this event.
Consent*
Yes
I understand that it is a requirement and agree to email marketing@lifelineconnections.org a minimum of 2 photos of myself and/or colleagues that may be used for promotional purposes while at the event.
Event Request Agreement*
Yes
The person picking up supplies will arrange a pickup time and drop off time to sign-in and out all supplies. They also agree to keep all items in good, clean condition and return everything within 3 business days of event conclusion.
Email
This field is for validation purposes and should be left unchanged.

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