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Program Request Form

To request any of our programs, please fill out the form below. Our Community Relations Unit will contact you within 24-72 hours to confirm receipt of your request and to review the details and to the best of our ability, schedule your event. Please note: Although we will do our best, filling out this form is not a guarantee that we can accommodate your request. For more information or to get in contact with our Community Relations Unit, please contact them by phone at (631) 852-5611, (631) 852-5636, or by email at william.blomberg@suffolkcountyny.gov or shi-anne.caraballo@suffolkcountyny.gov.

PROGRAM REQUEST FORM

Programs Requested (select all that apply for this event):

Thank you for requesting one of our presentations. Someone will get back to you within 48 hour business hours. If you need immediate assistance, please contact our Community Relations Unit at (631) 852-5611

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