Event Request Form

Please use this form to request Cecil County Health Department representation at your event.

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Contact Details

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Event Details

How many people will be in attendance?

Is the Event indoors or outdoors?

Indoors

Outdoors

What do we need to provide?

Table

Tent

Chairs

Please select all that apply.

Any Additional Event Information

Phone

This field is for validation purposes and should be left unchanged.