Alice! Health Promotion

Stressbusters

Stressbusters Request Form

IMPORTANT: * indicates required field 

In order to accommodate your request, we ask that requests be submitted at least two weeks before the scheduled event.

Your Information

Name: *

Title:

Organization: *

Campus Email: *

Campus Telephone: *

Event Time and Place

Date: *

monthMonthJanFebMarAprMayJunJulAugSepOctNovDec

dayDay12345678910111213141516171819202122232425262728293031

yearYear200020012002200320042005200620072008200920102011201220132014201520162017201820192020

Preferred Start Time: *

hourhour123456789101112

:

minuteminutes00153045

am

pm

Preferred End Time: *

hourhour123456789101112

:

minuteminutes00153045

am

pm

Is your event open to the Columbia community and would you want Stressbusters to electronically advertise the event? :

Yes

No

Location: *

Expected Number of Attendees*

Number 0f attendees: *

1-25

25-50

51-75

75+

Type of Event *

Event Type: *

Residence Hall Floor Event

Student Organization Information Health Fair

CU Staff Event

Other

If other, please explain:

Additional Comments

Comments:

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