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Mobile Site Request Form - use this form to request a mobile site event.
*
Name of the organization or business - Copy
*
Contact information
Name of contact person
*
First Name
*
Last Name
*
Phone
*
Email
*
Mobile site information
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands (US)
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces (the) Americas
Armed Forces Europe
Armed Forces Pacific
Army Post Office (U.S. Army and U.S. Air Force)
Fleet Post Office (U.S. Navy and U.S. Marine Corps)
State
ZIP Code
Date
*
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Month
Jan
Feb
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Day
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Year
2024
2025
Event start time
*
Hour
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Minute
:
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AM/PM
AM
PM
Event end time
*
Hour
01
02
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09
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12
Minute
:
00
01
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AM/PM
AM
PM
Will the event be indoors or outdoors?
*
Indoors
Outdoors
Is there access to an electrical outlet (for ID equipment)?
*
Yes
No
Is there access to internet (including WiFi)?
*
Yes
No
Number of people expected at the event (estimation)?
*
What type of event is this?
Arts or culture fair or festival
Legal clinic
Health fair
Neighborhood event (i.e. block party)
Other:
Other Value
Will services be needed in languages other than English or Spanish?
*
Yes
No
Which other languages are needed?
*
Any additional information to share?
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