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Oasis Event Request Form
Thank you for your interest in having Oasis attend your event.
Please complete the form below to help us best determine how to serve the community.
Click Submit when finished.
Organization Name*
Organization Type
For-profit
Non-profit
Contact Name*
Telephone*
Email Address*
Event Name*
Event Location Address*
Address Line 2
City*
State*
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Colorado
Connecticut
Delaware
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Hawaii
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Maryland
Massachusetts
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Montana
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New Hampshire
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Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Event Date*
RadDatePicker
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Calendar
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Start Time*
8:00 am
8:30 am
9:00 am
9:30 am
10:00 am
10:30 am
11:00 am
11:30 am
12:00 pm
12:30 pm
1:00 pm
1:30 pm
2:00 pm
2:30 pm
3:00 pm
3:30 pm
4:00 pm
4:30 pm
5:00 pm
End Time*
8:00 am
8:30 am
9:00 am
9:30 am
10:00 am
10:30 am
11:00 am
11:30 am
12:00 pm
12:30 pm
1:00 pm
1:30 pm
2:00 pm
2:30 pm
3:00 pm
3:30 pm
4:00 pm
4:30 pm
5:00 pm
5:30 pm
6:00 pm
6:30pm
7:00 pm
Event Fee
Yes
No
Fee Comment
Speaker Honorarium
Yes
No
Speaker Honorarium Comment
Event Description
Presentation/Speaking engagement
Table/Booth
Topics (Check all that apply)
Oasis Overview (all programs)
Volunteer Opportunities
Oasis Health Programs
Medicare Counseling/Marketplace
Oasis Tutoring Program
Table/Booth Type (Check all that apply)
Materials with staff or volunteer present
Health screening
Materials only
Materials Needed (Check all that apply)
Catalogs
Health fliers
Arts/Humanities fliers
Volunteer information
Expected Audience (Check all that apply)
Professionals
Older adults
Independent Living
Assisted Living
Comments About Your Audience
Special Instructions
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* Required