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Please give the Community Marketing Team an 8 week notice on all events and sponsorships.

Name of Requesting Organization:

Primary Contact:

Primary Phone Number:

Primary Email Address:

Name of Event:

Date of Event:

Start Time:

End Time:

Event Address:

City:

County:

Zip Code:

Expected Attendance:

Last Year's Attendance:

How many years has this event occurred?

How are you promoting this event?

Is this event indoors or outdoors?

Is this a health fair?

Services Requested
Cook Children’s Health Plan Overview
Medicaid Application Assistance
Star Plan Overview
CHIP Plan Overview
Star Kids Plan Overview
Oral Health
Safe Kids Poison Prevention
Sponsorship Request(List sponsorship amount in comment box)

Comment (Please add other information about the event here including the name of Marketing staff you are partnering with.)

Click here to upload a file. (We are currently accepting only .jpg, .png, or .pdf file types.)