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?