Community Engagement Form

Name

Organization

Email Address

Phone

Event Name

Event Date

Time

Services Needed from Art-Reach At Event

Tabling/Information Fair (Where Art-Reach Staff is Present) Tabling/Information Fair (ACCESS Admission Rack Card distribution only, No Staff Presence) Art-Reach Core Programs PresentationCultural Accessibility Training *Fee May Apply* Other

If other, Please Specify

Exact Location of Event:

Address Line 1

Address Line 2

City

Country

State

Provinces

State/Province

Postal Code

Duration of Presentation

30 mins1 hour2 hours

Please provide additional details about the event (example: Technology requirements, wifi, sound, iPad):

Please upload Event Flyer, Invitation, or Event Summary

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