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2. Event Name
4. Event Date
   Event Date Start Date

   Event Date Start Time

   —

   Event Date End Date

   Event Date End Time
6. Contact Name
8. Organization Name (if applicable)
10. Email
12. Phone Number
14. Name of Location (if applicable)
16. Address
18. Vehicle Request

    1. Mobile Library
    2. Make&Go
20. Is This a Recurring Stop?

    1. Yes
    2. No
22. If yes, what is your suggested day of the week, and suggested time of day? Will this be a monthly or bi-monthly stop? (Mobile Library only)
24. What age levels do you anticipate the Bookmobile or Make&Go serving? (choose all that apply)

    1. Preschool
    2. Children
    3. Teens
    4. Adults
    5. Seniors
    6. Families
26. Is the event inside or outside?

    1. Inside
    2. Outside
28. What is the expected attendance of this event?
30. What will be provided (table, chairs, power, cover, parking)? (if applicable)
32. Parking information ( where would we park?)
34. Will there be access to restrooms?

    1. Yes
    2. No

36. Please note:

    The Mobile Library is 24’ long and will need room to maneuver. The Make&Go is 21’ long and will need room to maneuver.

Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field