Event and Presentation Request Form

Please enter the details of your event in which you want MCSS to participate.

For presentations on the Safe Schools Maryland anonymous reporting system, visit http://bit.ly/SSMDPresentationRequests *NOTE: MCSS requires all event/ presentation requests to be submitted here five business days prior to the event/ presentation date.

Contact Details

Contact Name*

First and Last Name

Contact Title*

School / Organization

Contact Email*

Your Email ID

Contact Phone*

Your phone number

Details

Event Type

Select or enter value

Event Name*

Event Date*

Alternate Date if event is cancelled

Event Time

Start Time: End Time :

Event Location*

Address where the event is hosted

Select or enter value

Location Address

How big is the setup Space?*

10 ft x 10 ft

What is Provided?*

Select all that apply

Select or enter value

Parking

Free Street Parking

Free Lot/Garage/Valet Parking

Paid Street Parking

Paid Lot/Garage/Valet Parking

Paid Parking, but Free Parking Validation

Will food be provided?

Yes, food is included free of charge.

Yes, food is included, but attendees and vendors will need to pay.

No, food is not included.

Audience

Approximately how many attendees?*

Who will be attending?

Select all that apply

Select or enter value

Point of Contact

Point of Contact*

Are you the point of contact for the event?

Yes

No (Point of Contact is some one else)

Point of Contact Name

Point of Contact Title

Point of Contact Phone Number

Point of Contact Email ID

Comment*

Send me a copy of my responses

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