Event Title (if any) *
Event Host Organization and Chapter*
Is the event private and exclusive for your members only?*
Yes
No
Event Date*
Time*
Time Zone:
How much time does Mary have for her presentation?*
Does this virtual event have a hybrid element?*
Yes
No
Event Registration Page*
Number of expected participant (An estimate is appreciated)*
Conference Link*
Other information or concerns
Your Name/ Your Events Coordinator*
Phone number (ONLY for the day of the event, in case there is a last minute question or emergency)*
Your Events Coordinator's Email*
Submit