Chatham County Mosquito Control Department

Use this form to submit a request to Chatham County Mosquito Control for a Public Outreach Educational Event.

Organization Information

Name of Organization:

Contact Person:

Email Address:

Street Address:

City:

State:

Zip:

Phone Number:

Ext:

Alternate Phone Number:

Ext:

Program Information

Location of Program:

Street Address:

City:

State:

Zip:

Date of presentation:

Time of presentation:

Duration: (In Hours):

Age Range of Participants:

-

Number of Participants:

Program Emphasis:

Environment:

Remarks:

Please note that during mosquito season, some programs may be cancelled because of weather conditions and/or current workload. Some out-reach programming may require site inspection by staff prior to event.