West Virginia FREE

WV FREE
PO Box 11042
Charleston, WV 25339
304-342-9188

Events

West Virginia Emergency Contraception Event Notification Form

Required Field *

Email Address *
Name
Organization *
Contact Phone
Mailing Address
City
State
Zip Code
Information needed to post the event on our shared calendar and Web site:
Event Location
Event Date
Who Is Invited?
Who should people contact with questions (e-mail or phone number)?

Please provide a 3-5 sentence description of your event:

Information needed for planning and coordination purposes:

Resources and Materials needed: (List the amount to all that apply):
	Giveaway Items
	Information Brochures for Men and Women
	Information Brochures for Health Providers
	Project Brochures
	Other (please specify)

Who will be involved in the planning and execution of the event? (Please include information on organizations, sponsors, etc.)

What is the goal of the event? What do you hope to accomplish by doing the event?

Are you willing to speak with the media about this event? If yes, please provide the specific date(s), time(s), and place(s) when you would want media coverage?

How will you know you have been successful? (What measure of victory will you use? For example, you might aim at a specific number of petition signatures or letters written or a number of participants, media coverage, policy change, and/or the establishment of local activist groups.)

Would you like for someone from the Initiative to attend your event? How would you like for Initiative staff to assist you?

Please take a moment to double check your submission before sending it.