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Community Event & Education Request Form (H-9)

The City of Milwaukee Health Department is committed to community outreach and education. Each request or event attendance is evaluated on a case-by-case basis. Requests should be made at least 30 days in advance. Requests within a shorter timeframe will be accommodated if possible. Please note: You may be contacted by a designated City of Milwaukee Health Department staff member for further information.

Type of request

 Table/BoothPresentation  Testing/Direct Service
 Brochures  Other

Organization


Name of Organization

Organization Address

Contact Person

Telephone  

Email

Type of Organization

 Government  Faith-based Organization
 Non-profit  School
 Business Healthcare Organization
 Other  Please explain:

Event


Date                        

Time  

Location IndoorOutdoor

Vendor set-up time  

Purpose Event
What other partners are involved?


What amenities will be provided by the event organizers?
Wireless Internet
Tent
Table & Chairs
Meals
Drinks

Estimated Audience
0-50
50-100
100-200
200-500
500 & above

Audience Demographics
K-5th grade
6th grade -12th grade
Adults
 

Please select up to 5 topics for representation

Communicable Disease & Immunizations Infant & Family Health
Diagnostic Testing Lead Poisoning Prevention
Domestic Violence Prevention Men’s Health
Emergency Preparedness Sexually Transmitted Diseases
Environmental Health Tattoo & Body Piercing
Food Safety Teen Pregnancy Prevention
Health Insurance Access & Public Benefits Women’s Health (Breast & Cervical)
Home Environmental Health (Asthma & Mold)

 

Please wait while we gather your results.

Health Department Locations


Administrative Offices

Frank P. Zeidler Municipal Building
841 N Broadway, 3rd Floor
Milwaukee, WI 53202-3653
(414) 286-3521

Northwest Health Center

7630 W Mill Rd
(414) 286-8830

Keenan Health Center

3200 N 36th St
(414) 286-8840

Southside Health Center

1639 S 23rd St
(414) 286-8620