HAAC Event Questionnaire Name * First Name Last Name Email * Name of Event * Date of Event * MM DD YYYY Start Time of Event * Hour Minute Second AM PM Event End Time Hour Minute Second AM PM Event Location * Address 1 Address 2 City State/Province Zip/Postal Code Country Primary Audience of Event Point of Contact (if different from above) Event Website http:// Are vendor tables allowed? * Yes No Is there a flyer associated with the event? If there is an event flyer, a Healthy Anne Arundel staff will contact you for more information. Yes No Additional Information Thank you!
