GTSC CPS Event Submission

Child Passenger Safety (CPS) Event Submission Form

Use this request form to have a CPS event posted on the GTSC website.

1. Event Type: *This question is required.

2. County: *This question is required.

3. Grant Number of the Hosting Agency:

4. Date (must be submitted at least 5 business days before event):
(If multiple days, this is the starting date.) *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

End Date:
(If the event is over multiple days, this is the final date.) This question requires a valid date format of MM/DD/YYYY.

calendar

5. Time: *This question is required.

Starting Time
Ending Time

6. Participant Cost: *This question is required. This question requires a valid number format.

$ per participant

Payment must be made to: *This question is required.

7. Safe Kids Course ID #:

8. Location and Contact details: *This question is required.

Location Name

Street Address

City

State

ZIP

Contact Person

Contact Phone Number (in format 555-555-5555)

Contact Email

9. Event sponsor(s): *This question is required.

Sponsor 1
Sponsor 2 (if applicable)
Sponsor 3 (if applicable)
Sponsor 4 (if applicable)

10. Media provider(s):

Provider 1
Provider 2 (if applicable)
Provider 3 (if applicable)
Provider 4 (if applicable)

11. Your email address:
(This will be used to confirm your submission.) *This question is required. This question requires a valid email address.

12. Appointment information (if applicable):

Your event will be posted to the GTSC website at http://trafficsafety.ny.gov. When you submit this form, a copy of your response will be sent to you, Aubrey Feldman, and any other necessary GTSC staff.

New York State Governor's Traffic Safety Committee (GTSC)

Child Passenger Safety (CPS) Event Submission Form

GTSC CPS Event Submission

Child Passenger Safety (CPS) Event Submission Form