[DC GOVERNMENT] OHCOBR Outreach Event Request

Office of Health Care Ombudsman and Bill of Rights
(OHCOBR)
Event Participation Request

Complete this form to submit a request for members from the OHCOBR to participate in your event.

Organization/Agency Name

Point of Contact Name

Phone Number

Date and Time of Event

Anticipated Attendance

Description of Event

Event Address

Address or Location

Address Suite/Room Number (if applicable)

Additional Comments

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