All Kids Presentation Request

Complete the following information:

Contact Information
Contact Name
Organization
Address
City
State
Zip
Phone
Fax
E-mail
Type of Event (select one)
Presentation
Booth
Other
Event Information
Event
Date
Time
Location
Address
Number of Attendees
Individuals requiring reasonable accommodations should contact the Illinois Department of Healthcare and Family Services ADA Coordinator at 217-785-9534 phone, or 217-782-0936 TTY, or e-mail Healthcare and Family Services at least ten (10) business days prior to the event they would like to attend.

All Kids Hotline 1-866-ALL-KIDS (1-866-255-5437)
TTY: 1-877-204-1012