Events

Community Van Partner Request Form

Please submit your request at least 4-6 weeks prior to your event if you would like the van present at your event. Once your request has been submitted, you will receive a confirmation via email. Thank you.

"*" indicates required fields

Organization Contact Name*
MM slash DD slash YYYY
Event Location Address*
Please enter a number greater than or equal to 12.
Screening Sign-Up Requirement: To ensure we can bring the appropriate services and staff to your event, PECaD requires that at least 12 individuals are signed up for screening services at least two weeks prior to the event date. Meeting this requirement helps us prepare the best experience for your community. If it isn’t met, PECaD may not be able to provide screening services as planned. When possible, we will work with partners to explore alternative options such as health education or prevention materials.
What screenings or services would you like at your event?” with a simple checklist format (check all that apply)
Do you need marketing support?*
Are you requesting services in Missouri or Illinois?*

 

PECaD Community Events

 

PECaD Community Events Request Form

Please submit a form at least 4-6 weeks prior to your event if you would like to partner with us. Once your request has been submitted, you will receive a confirmation via email. Thank you.

  • MM slash DD slash YYYY
  • Please enter a number greater than or equal to 10.