IDHS Special Event Request Form

Please complete the following form when requesting IDHS participation in a public or community event or training. This will help the agency determine availability and resources so it can respond accordingly to your request. Participation will be dependent on the availability of staff, equipment and other resources, so please note that IDHS cannot fulfill all requests for reasons such as distance, time and resources needed. Please expect a response to this request within five working days.

Name of Event Contact (Requester)

Email Address

Phone Number

Event Name

Event Location

Event Start Date

mm/dd/yyyy

Event End Date

mm/dd/yyyy

Event Hours (e.g., 8 a.m. to noon)

Describe the event, including its purpose and audience. Please be descriptive.

Expected Attendance

IDHS Equipment Requested

What additional resources may be needed? (For example, are tables or chairs needed and who will provide them?)

IDHS Speaker Requested

If requesting an IDHS speaker: What expertise or insight do you want the speaker to share?

If requesting an IDHS speaker: What is the speaker's estimated time commitment?

Is this a paid sponsorship opportunity? If so, please describe and include contact information.

Send me a copy of my responses

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