Publicity Request Request Type*Select all that apply Event Registration Request Graphic Request Online Form Request Event InformationSubmission Status*Select...Save the Date - More info will be available in the futureFinal Publicity InformationEvent Type*Select...Education ProgramLeverage Your BeverageMonthly ProgramWorkshopOtherDescribe Event Type*Event Date* Date Format: MM slash DD slash YYYY Event Time* : HH MM AM PM Member Cost*Non-Member Cost*Location 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 Event Title*Event Subtitle*Event DescriptionLearning ObjectivesProvide 2-3 bullet points per field that attendees will take away from this event. If this is a graphic only or form only request please type "N/A" into the fields below.You will gain insight into:*You will walk away with these benefits:*You will find answers to:*Does this event offer CEUs (program/education/training event)? Yes, add one CEU/hour to the graphic and event description Speaker InformationSpeaker Name First Last Speaker TitleSpeaker CompanySpeaker bio, headshot, etc. Drop files here or Sponsor InformationSponsor Contact Name First Last Sponsor CompanySponsor Contact Email Sponsor Logo Drop files here or Graphic InformationGraphic TitleDesired Theme/Color PalletteGraphic TextSpecial InstructionsFor graphic only requests, please include graphic size and any other relevant information.Graphic Type Electronic Printed Additional Graphics Drop files here or Online Form InformationWhich pages would you like this form to be added to?MembershipMentoring ProgramCRM UsersPhelix AwardsSoftware TrainingCPSM CertificationLending LibrarySponsorMember-Only AreaOtherForm Application/Entry Fee Amount(s) (if applicable)Please list what other page where this form should be addedPlease attach a PDF or Word document with all required form fields Drop files here or Requester InformationName* First Last Phone*Email* Publicity OptionsHow should this event be publicized? Website Weekly Email Blast Social Media Video Domain(s) of PracticeSelect all applicable Domains of PracticeDomain 1: Marketing ResearchDomain 2: Marketing PlanningDomain 3: Client and BusinessDomain 4: ProposalsDomain 5: Promotional ActivityDomain 6: ManagementPhoneThis field is for validation purposes and should be left unchanged.
