Special Events Application | Sarah Bush Lincoln

Your name: *
First & Last

Organization/School/Community Club or Group: *

Phone: *

Email: *

County the event will take place: *

Name of Event: *

Type of event: *
check all that apply

If Other, please explain:

What is the ages of the participants: *
check all that apply

Describe your event and request: *

What is the goal of the activity or event: *

What is the expected number of participants: *

What is the date of the event: *

What is the time of the event: *

What is the expected set-up or tear down time? *

What program or vehicle are you asking to participate: *

SBL Healthy Kids Programming

CORD (Community Online Resource Directory)

SBL Dental Services - Oral Health Education

SBL Healthy Communities Programming / Partnership

The Kickstart Car

The Dental Bus

If you selected Dental Bus, please choose option:

Oral Health Education

Tours

Parades only

Healthy Communities Special Events Application