Event Name Event Address Site Address Address Line 2 City ZIP State Country - None -United States Contact Person Phone Email Event Sponsor Event Organizer Permitted MW Generator Event Type Vaccination Clinic Health Fair Blood Drive Stand Down Event Other… Specify if Other Event Date List Additional Dates How will the medical waste be managed after the event? Medical Waste Disposal Hauler or Mailback Company Facility ID# (FA#) Facility Name Facility Contact Person Facility Contact Phone Facility Contact Email Leave this field blank
