Request for Scheduling Expressive Activity Form

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REQUEST FOR SCHEDULING EXPRESSIVE
ACTIVITY FORM

Organization Information

Organization distributing information/products:

Address:

City:

Zip Code:

Contact Information

Name:

Phone:

Address:

City:

Zip Code:

Email:

Date Submitted:

Description and purpose of information/food to be distributed

Upload copy of information

Upload copy of driver's license for each individual participating

Requested dates and times of distribution:

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