Submit a New RCC Event

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Name*

First Last

Email Address*

Event Name*

Event Venue*

Event Street Address*

Event City*

County*

Event State*

Event Zip Code*

Event Date*

Event Start Time*

Event End Time*

Event Type*

Event Screening Type

RuralCare Connect Services Offered*

Describe the services RuralCare Connect will offer at this event [information, screenings, resources, etc.]. Be as descriptive as possible.

Event Details*

Tell us everything you can about the event — activities, vendors, speakers, entertainment, or other highlights. The more information you provide, the better we can promote the event to potential attendees.

This event is:*

Public

Private

Registration is:*

Required

Strongly Encouraged

Not Required

Are walk-ins welcome?*

Yes

Event Capacity

Please enter a number from 1 to 999.

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