The Dewitt Center Program Intake Form

Please answer the questions below about your program at The Dewitt Center.

If you have any questions regarding The Dewitt Center please contact Erica Davis, The Dewitt Center Director at edavis@madison-park.org.

If you have any questions regarding marketing please contact Kelly Lydon, Director of Communications and Public Affairs, klydon@madison-park.org.

Contact Name

Email

Organization/Sponsor Name

Program Name

Program/Organization Website

Program Age Range

School Age (5-12)Youth/Teens (13-20)Adults (21+)Seniors (60+)

Date/Time(s) of Program

Program Description for The Dewitt Center Catalog

Will you be promoting this program? If yes, where/how?

The Dewitt Center has my logos and marketing materials

YesNo

Please upload your logo here

Please upload your marketing materials here

Contact Information