Southeast Texas Poison Center Request for Health Fair/Lecture

Social distancing has changed the way we do education at Poison Centers across the country. Education is vital to staying safe and knowing what to do when poison emergences or questions arise. Poison centers are still operating normally at 1-800-222-1222.

Southeast & Central Texas Poison centers are offering education via social media platforms (excluding any forms of news outlets). We are available to provide presentations via Webex.

Please fill out all required fields below.

Requesting Organization*
Address*
Street Address Address Line 2 City County ZIP / Postal Code
Contact Person*
First Last
Contact Email*
Phone*
Day of Event Contact Person*
First Last
Day of Event Contact Phone*
Type of Event*
Please specify...*
Duration of Event*
Audience*
Please explain...*
Event Date*
MM slash DD slash YYYY
Event Time*

: Hours

Minutes

AM/PM
Event Location
- Same as Organization Address
Event Address*
Street Address Address Line 2 City County ZIP / Postal Code
Estimated Number of Attendees*
Venue Type*
Please explain...*
Will table and chairs be provided?*
- Yes
- No
Is a laptop and projector available for use at the venue?*
- Yes
- No
Spanish materials needed?*
- Yes
- No
Estimated amount needed*
Has the Poison Center done an event for this organization before?*
- Yes
- No
How did you hear about us?*
Please explain...*
Special Instruction, Comments and Event Details*

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Southeast Texas Poison Center Request for Health Fair/Lecture

FOR IMMEDIATE HELP, PLEASE CALL 1-800-222-1222

Southeast Texas Poison Center Request for Health Fair/Lecture

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FOR IMMEDIATE HELP, PLEASE CALL 1-800-222-1222