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  • Please complete the form below, and click SUBMIT. All request forms must be submitted at least 60 days prior to the event. Submission of this request form does not guarantee participation. You will be contacted by the National Kidney Foundation of Maryland within one week of your request. If you have any questions call 410.494.8545 or email dlucadamo@kidneymd.org.

    (All Fields are required)

    I am requesting: Table/information boothHealth screeningWorkshop/health presentation

    Event Information:
    Event Name:
    Event Date:
    Event Address:
    Organization/Company Name:
    Event Start Time: a.m.p.m.
    Event End Time: a.m.p.m.
    Target Audience for Event:
    Number Expected to Attend:
    Event description: (purpose, # of years, etc.)

    What other organizations will be participating in the event?

    Will there be other screenings happening? If yes, what type of screenings (blood draw, blood pressure, etc.)

    How will the event be marketed? Will NKF-MD have the opportunity to be included in marketing and media outreach?

    Is this event be inside or outside? InsideOutside

    Will tables and chairs be provided? YesNo

    What parking will be available for the NKF-MD volunteers and staff? Please describe location (parking lot, street parking, etc.):

    Contact Information:

    Contact Name:
    I am a: VolunteerOrganization/company employeeCommunity Organizer
    Contact Email Address:
    Requesters Phone Number:
    Requesters Mailing Address:
    Preferred Contact: EmailPhone
    Preferred time to contact:
    How did you hear about NKF-MD screenings?