General Questions:
Vice-President - Bill Scott
President - Todd Conklin
Secretary/Treasurer - Jim Taber
Please give us 5 business days to process your Event request. After the request is approved,
you will receive a confirmation email with all details of the request. If the confirmation
is incorrect, please contact us at the phone number listed in the confirmation email.
Type of Event:
Phone:
Email:
Other Comments:
Date of your event:
Event Start Time:
City:
Address of Event:
State:
Zipcode:
Time event will end?
Second Contact:

Name:
Phone:
Email:
First Contact:

Name:
Arrival time for "Ida Mildred":
Can we sell Pink Heals Merchandise?
Event Location (i.e. Business Name/Park Name):
Event is Indoor or Outdoor:
Is Event open to Public?
Event is a Fundraiser/Benefit for:
Do you need us to speak at Event:
Please list any special instructions:
(Placement of truck, sales table, will the
truck participate in a parade, etc.)
Is there a Webpage or Facebook page
for your Event:
What color is the sky?
Only someone affiliated with the event, should submit the form.
If you are interested in having "Ida Mildred" (the PINK fire truck) at your event,
please fill out the form.
All fields required

info@pinkhealsmemphis.com