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 Healthy Anne Arundel Coalition supports community events that are accessible, adaptive, and inclusive for individuals with disabilities. Who is the contact person for anyone needing accommodations to attend or participate in this event? First Name Last Name Phone (###) ### #### Email Thank you!
