South Carolina Emergency Contraception Event Notification Form
Name*
Name of Organization *
Phone number
Address 1
Address 2
E-mail address*
Exact location of event
Date of event
Who is invited?
Who should people contact with questions (e-mail or phone number)?
Provide a three- to five-sentence description of the event.
Resources and Materials needed: (List the amount to all that apply): (See a list of materials we offer) Give-away items Informational brochures for young women and men Informational brochures for health care 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.)