This form is for Partners to submit U.S. Antibiotic Awareness Week activities taking place in 2017.
Address of Event:*
Organization Web Address:
Name of Activity:*
Activity Date and Time:*
Target Audience: *
Activity Description: *
Evaluation and/or Follow-up Plans: Include any information you plan to obtain and report such as: number that attended and/or received materials, website metrics, social media metrics, where applicable, information requests that were difficult to meet, lessons learned, etc.
May we post your city and activity description on the U.S. Antibiotic Awareness Week Website?
May we contact you?
May we post your contact information with your activity?
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