Request for Public Outreach Educational Event  

Use this form to submit a request to Chatham County Mosquito Control for a Public Outreach Educational Event.

Organization Information

Name of Organization:
Contact Person:
Email Address:  
Street Address:
City:
State:
ZIP:
Phone Number:
Ext:		    
Alternate Number:
Ext:		    

Program Information

Location of Program:
Street Address:
City:
State:
ZIP:
Date and time of presentation:
Duration:
Age Range of Partticipants:
Number of Partticipants:
Program Emphasis:
Environment:

Remarks:

Please note that during mosquito season, some programs may be cancelled because of weather conditions and/or current workload.  Some out-reach programming may require site inspection by staff prior to event.
Home | FAQs | Service Request | Our Methods | Tiger Mosquito | Mosquito Borne Diseases | Education | Links

Privacy Statement  |  Terms Of Use

© Copyright 2012 - Chatham County - Mosquito Control