Event Name*RecurrenceOne Time EventMeets WeeklyMeets MonthlyDate(s) of Event*Please enter date(s) as mm/dd/yy OR enter start date (mm/dd/yy) and nature of recurrence (e.g. 01/01/16, every Monday through 01/01/17).If scheduled regularly, please add any other details, as needed.Event Starting Time/ Set Up Time*Event Finishing TimeLocation (Desired)How many expected?Contact Person* First Last TelephoneEmail Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CellContact Staff PersonEquipment required (tableware, AV, etc.)Conference Phone?YesNoCall-in/Bridge Info?YesNoDisplays required (easel, poster, table display)Child care needed?YesNoNumber of ChildrenAgesAdditional Requests or CommentsOrganization/Committee
