Community Event Submission Form Thank you for your interest in partnering with the Anne Arundel County Department of Health for your upcoming event. We offer our display resources to public events, such as health fairs, in Anne Arundel County in order to inform the community about important health topics. To request that the Department participate in your event or provide materials, please complete the event request form at least two weeks prior to the event.All requests are reviewed once received. Our ability to honor your request is based on staffing and date. The form is a notification to the Office of Communications and not a confirmation that the Department will participate. Depending on those items, we may be able to provide staff and materials or just materials. If we only are able to provide materials, you may have to coordinate a pick-up date and time with the Office of Communications.If you have any questions or cannot fill out the online form, contact 410-222-4508 or hdpio@aacounty.org. Contact Information Name Email Phone Sponsoring Organization Information Organization Sponsoring Event Type of Sponsor Business Community Group Faith-based Government Hospital Nonprofit Organization School Other… Enter other… Event Information Event Title Brief Description of the Event (include any website link): Date Event Date Event Rain Date Time Event Start Time Event End Time Vendor Setup Time Event Location Venue Name Address Address 2 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 ZIP/Postal Code Type of Event (Choose all that apply) Online In-person Hybrid Indoor Outdoor Other… Enter other… Is registration required? Yes No How many years have you held the event? Expected Attendance 0-50 50-100 100-200 200-500 Other… Enter other… Other Exhibitors Target Audience Description Are Tables and Chairs Provided? Yes No Fee to Participate? Yes No Event Fee Is event in a smoke-free and vape-free environment? Yes No COVID-19 Guidelines Social distancing and masks required Social distancing and masks recommended None Do you have an image to accompany this event post? Yes No Image Upload One file only.100 MB limit.Allowed types: gif, jpg, jpeg, png. DOH Programs/Services/Information Requested Behavioral Health (Check all that apply.) Adult Substance Misuse Treatment and Recovery Child Adolescent and Family Mental Health and Substance Misuse Services Substance Misuse Prevention and Education Diseases and Immunizations (Check all that apply.) Bioterrorism Cancer Prevention Emergency Preparedness Hand Washing Heart Health HIV/AIDS Services Immunizations Infectious Diseases Influenza/”Flu” Tuberculosis Services Sexually Transmitted Infections (Diseases) Environmental Health (Check all that apply.) Bay Restoration Fund Food Safety Housing and Property Raccoon Oral Rabies Vaccination Project Recreational Water Quality Wells and Septic Systems Infant, Children and Adolescent Services (Check all that apply.) Babies and Toddlers Health Behavioral Health (Mental Health and Substance Use) Dental Health Healthy Eating and Physical Activity Immunizations Lead Poisoning Prevention Medical Assistance Parenting Sun Safety Teen Health Tobacco Use Prevention Women, Infant and Children (WIC) Nutrition Uninsured or Low-Cost Health Care (Check all that apply.) Adults Dental Health Families Low-Cost Medical Resources Prescription Savings Program Transportation and Other Resources Mailing Address (If materials need to be sent): Name Address Address 2 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 ZIP/Postal Code Additional Information Leave this field blank
