MEDSTAR PUBLIC OUTREACH REQUEST

MEDSTAR is committed to providing the up-to-date information to residents, visitors, partners and the community-at-large. If you are interested in learning more about MEDSTAR and would like to have a MEDSTAR representive(s) meet with you please complete the below information.

Organization or Event

Request Type

Date of Event (mm/dd/yyyy)*

Time of Event (hh:mm AM or PM)*

Contact (First Name) *

Contact (Last Name) *

Phone Number*

Fax No.

E-mail Address*

 Location of Event*

City*

Zip Code*

County*

Request Comments & Description of Proposed Landing Area:*

Expected Attendance*

Age Range of Participants:

Delay Acceptable

Day of Event (this is the contact information for the day of the event, if other than above.)
Contact

Phone Number

* indicates required fields