Event Information

* indicates a required field
* Event Name     
 *Event Type    
*Event Address      
*City      
*State               * Zip       
Location    
*Event Date       
 
*Event Start Time    
*Event End Time    
*Requested Time Start 
(time for CCFD to be there) 
 
*Requested Time End    
* Reason for Request  
(Up to 250 characters. Please provide specific details. This information will be utilized in the approval process.)  
   

Contact Information

Organization  
Non-Profit Organization?  
If you answered yes to above, please provide your Non-profit organization ID#  
 *Contact Name      
*Address Type    
*Is address Outside US?     
*Address      
*City      
*State               * Zip       
*Contact Phone     ex. 702-555-5555      
Alternate Phone     ex. 702-555-5555   
FAX     ex. 702-555-5555   
*Email        
If you have an e-mail ending in "@interact.ccsd.net" please use an alternate e-mail address as our system is currently having issues with this domain. We hope to have this resolved soon. Thank you for your patience and understanding.

Atendee Information

* Number of Adults     
 * Number of Children      
(type 0 if no children in attendance)
* Age Range of Children      
ex. 10-12 or 0 if no children in attendance
*  Grade Level      
                                         

If your event is successfully submitted, you will receive confirmation on the next page.