WCCHD

Williamson County and Cities Health District focuses on community outreach by attending local health fairs and various community events to raise public awareness about preventative health services. Please fill out the information below to submit a request.
Event Information
Please complete all information
Date of Request:	mm/dd/yy
Date Response Needed:	mm/dd/yy
Date of Event:	mm/dd/yy
Set Up Time: Start Time: End Time:
Organization Name:
Event Location Name:
Address:
City:
Zip:
Expected Number of Attendees:
Expected Audience:	Children/Families Teens College Students Adults/Seniors
Environment:	Indoor Outdoor Table Provided Chairs Provided
Type of Information Requested: (check all that apply)	General Immunizations Social Services WIC Activity/Demo Speaker and/or Presentation
Purpose/Goal of Event:
Contact Information
First Name:
Last Name:
Phone:
Email:
Additional Information:
	This form may also be downloaded and emailed to debra.strahler@wilco.org

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