Your name Your Phone Number Your Email Event Name Event Type (choose from list) Annual Event Breakfast Community Event Educational Event Fundraiser Legislative Event Mixer Networking Event Event Start Date (MM/DD/YYYY) Event End Date (MM/DD/YYYY) (Should be same as event start date unless multiple day event) Event Start Time 1 2 3 4 5 6 7 8 9 10 11 12 : 00 05 10 15 20 25 30 35 40 45 50 55 PM AM Event End Time (not required, leave blank if unknown) 1 2 3 4 5 6 7 8 9 10 11 12 : 00 05 10 15 20 25 30 35 40 45 50 55 PM AM Event description, details and additional information Email address for questions about the event. (not displayed publicly) Location/Directions Physical address where the event will take place. (No PO Boxes) City State Zip Phone number for questions about the event. (displayed publicly) Special Registration URL - Enter the full path URL (For example, http://www.website.com) Overriding Weather Information Link Leave this box blank if you have entered the Zip Code Overriding Map Link