Participation Request

Please complete this form if you would like to have our organization participate in an event or initiative your organization or company is hosting.

I understand that the Partnership for Children of Cumberland County's focus is children birth to five years old and their families. While an event or initiative may have older children or families with older children, it must also include our focus area to be considered.

Yes, I understand.

Information about you and your organization

Your First Name

Your Last Name

Your Phone

Your Email

Organization Name

Address

City

State

ZIP Code

Website

Link to social media page

What type of event or initiative is this:

Outreach EventSeminar/WorkshopPresentationCollaboration/Partnership

Is this a first time event?

YesNo

How many years has this event been held?

Tell us about your outreach event

Name of Event

Date of event

Event Set-up Time

i.e. 11:00 am - 1:00 pm

Event Start Time

i.e. 11:00 am - 1:00 pm

Event End Time

i.e. 11:00 am - 1:00 pm

Name of the Location

i.e. Crown Complex, Festival Park, Ft. Liberty

Address

City

State

ZIP Code

Is this event

InsideOutside

Expected Attendance (Number)

Target Audience (Families, businesses, etc.)

What is provided for the space? (Table, tent, chairs, electricity, etc.)

Tell us more

Name of Event (is this a board meeting, a staff presentation, funder presentation, etc.)

Date of event

Time of event

i.e. 11:00 am - 1:00 pm

Name of the Location

i.e. Crown Complex, Festival Park, Ft. Liberty

Address

City

State

ZIP Code

Expected Attendance (Number)

Target Audience (Families, businesses, etc.)

What is your expectation? (Time limits, any specific topics/programs, etc.)

What type of technology is available?

Tell us what type of collaboration you have in mind.

Be as specific as possible:

What is your expected outcome of this collaboration?

If we are unable to attend, would you like us to provide outreach materials?

Contact Information