School and Community Visit Form
School / Organization Name
Contact Name
Email Address
Phone Number
(###-###-####)
Event Name
Date of Event
(Please schedule one month in advance)
September 2024
Sun
Mon
Tue
Wed
Thu
Fri
Sat
36
1
2
3
4
5
6
7
37
8
9
10
11
12
13
14
38
15
16
17
18
19
20
21
39
22
23
24
25
26
27
28
40
29
30
1
2
3
4
5
41
6
7
8
9
10
11
12
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Today
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Start Time of Event
End Time of Event
Type of Organization
Type of Request
Approximate Number of Attendees
Target Audience
Audio / Video / Electricity Equipment Availability
Event Location
Street Address
City
State
Zip
County
Additional Information
*Safety Trailer Demo cannot be held in rain/inclement weather
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Jackson EMC