Test.Miami@flhealth.gov

Submit an Event

General Information

Organization *

County *

First Name *

Last Name *

Email Address *

Phone Number *

Event Information

Event Name *

Event Contact Person *

Event Website *

Event Phone Number *

Event Address *

City *

State *

Zip Code *

Date of Event *

Event Time *

Event Description *

Will a mobile testing unit be used at this event? *
Yes No

Enter Confirmation Number