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2. Group / Organization Name*
4. Primary Contact -First Name*
5. Primary Contact - Last Name*
7. Phone Number*
9. Email Address*
11. Description of Booth / Activity*
13. Need Activity Ideas?

    If you need an idea for your booth activity, let us know. We have put together a book of ideas and resources. Please reach out to Rob at Rhephner@pinetoplakesideaz.gov .

15. Amount of Space Needed*
17. Electronic Signature Agreement*

    By checking this box, you agree to supply prizes for all participants engaging in your activity. Prizes can be small toys or candy. You will need 500-1,000 pieces. If you need resources, please reach out to Aderosier@pinetoplakesideaz.gov

    1. I agree.
19. Electronic Signature
Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field