Screening Event Request - LASH Maryland

Name of Event

Sponsoring Organization

Address of Event

Start Date

End Date

Start Time

End Time

Contact Person

Phone

Email

Expected Attendance at Event

Location of Event

Indoors

Mobile Health Unit (subject to availability)

Screenings Requested

Vision

Preschool Children Vision

Hearing

Glaucoma

Indoor Screening Requirements - Sponsoring organizations must provide the following for an indoor event:

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