Ontario County Public Health

REQUEST FOR EDUCATION

If you would like to have us provide a program of education, you may call 585-396-4343 or 1-800-299-2995 or use the contact form below.

Public Health Educator
Alice Robeson, MSN

Address
3019 County Complex Drive
Canandaigua, NY 14424-9505

Telephone
585-396-4343 / 800-299-2995
Fax: 585-396-4551

Please fill out this form if you wish to request an educational program by email.

First Name:*
Last Name:*
Telephone:* (days - 8am to 5pm)
Topic:*
Date/Time:*
Organization:*
# Participants:*
Address*
Address2:
City:*
State:*		Zip:*
Email Address:*
Please Confirm Your Email Address:*
Type of Audience (professional, church, community, etc.)*
When would be a good time to reach you?*
Comments
The information with the * is required.