Complete the event planning form below. You will receive the Rx for Summer Reading Promotional Guide within one week of completing this form.

Practice/Clinic Name

Contact Name

First Name

Last Name

Email

Date of Event

MM

DD

YYYY

Time of Event

In Office Event

Virtual Event

Both

Activities Planned

Will you be including other literacy or community partners in your event? If so, who? Please provide contact information.

Please check any of the items below you need assistance with for your event.

Poster/Flyer

Virtual Event Assistance

Creation of site specific social media posts