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Organization Information
Organization Name
Your Name
First Name
Last Name
Your Email
*
Verify Email
*
Your Phone
*
Event Information
Event Name
Are you the primary contact for the event?
*
select one
Yes
No
Event Contact Name
First Name
Last Name
Event Contact Email
Verify Email
Event Contact Phone
Event Date
*
(mm/dd/yyyy)
Event Start Time
*
example: 11:00 am
Event End Time
*
Example: 3:00 pm
Event Description/Details
*
Is registration required?
select one
Yes
No
Event Registration/Ticket URL
Is there a cost to attend the event?
select one
No, the event is free
Yes
Cost to attend event
Anything special we should note?