Sponsors / Partners

HELPING PROVIDERS EVENT APPLICATION

(Please submit application by August 31, 2010) 

Event Location: Tucson Electric Park

2500 E. Ajo Way, Tucson, AZ 85713

Saturday, October 23, 2010

9:00am – 3:00pm

Providers will be able to access the venue at 7:00am.  All tables must be set up no later than 9:00am


AGENCY NAME: *
ADDRESS: *
CITY/ST/ZIP: *
CONTACT NAME: *
EMAIL: *
PHONE: *
CONTACT CELL:
TABLE REQUIREMENT: *
CHAIRS REQUIRED:
ELECTRICAL:
Please provide a brief description of the direct services you will be providing:
Did you particpate last year?:
If Yes, How many did you serve?:





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