CBHEC Mobile Education & Outreach

MOBILE EDUCATION & OUTREACH

Please complete and submit a request form if you would like to partner with Texas A&M Healthy South Texas to utilize our Mobile Clinic for your health or community outreach event.

Requests should be submitted 4-6 weeks prior to your event.
Once submitted, please allow 1-2 weeks for confirmation.

* indicates required

Requesting Organization *

Event/Occasion *

Primary Contact *

Daytime Phone

( ) -

Mobile Phone at Event

( ) -

Email Address *

Purpose of Event *

Start Date of Event *

End Date of Event *

Event Location

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Preferred format

HTML Plain-text