Program/Event Request Form

Program Event Request Form

Contact Name: (required)

Organization Name:

Contact Email: (required)

Contact phone #:

Organization Mailing Address:

Date Requested: (1st Choice)

Date Requested: (2nd Choice)

Start Time Requested: (1st Choice)

Start Time Requested: (2nd Choice)

Program/Event Interested in:

Specific Program:

Location of Outreach Program or Event:

Number of Participants: (Outreach Program or On-site@BPRC)

Age/Grade Level of Participants: (Outreach or On-site)

Number of Hours Needed: (Applies to Event Booth only)

Other information/questions:

Would you like your event advertised on our 'Public Events' page on our website?


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