Event Request - Florida Department of Health in Orange County

Community Outreach Events

Please complete this form to request the Florida Department of Health in Orange County’s participation in a health fair or community outreach event. Submission of this form does not guarantee participation in your upcoming event. Participation is based on staff availability and focus areas.

Event Name(Required)

Event Date(Required)

Event Start Time(Required)

Event End Time(Required)

Event Address(Required)

Purpose of Event

Contact Name(Required)

Contact Information(Required)

Sponsor Organization

Anticipated number of attendees(Required)

Services Requested(Required)

Event target area/population:(Required)

Is the event inside or outside? If outside, will shade be provided?(Required)

Will tables and chairs be provided?(Required)

Yes

Is there a registration fee? If yes, what is the amount?(Required)