VIRTUAL EVENT FORM

Committee Hosting the Event:

Name of Primary Contact

Email Address

Phone Number of Primary Contact

Name of Event

Proposed Date of Event*

Proposed Time of Event*

What time will the event conclude?

What Kind of Format will the event be held in? What Kind of Format will the event be held in? Webinar - Attendees in Listen Only (up to 500 people) Meeting - All attendees participating (up to 99 attendees)

Please include a description for the event*

Will there be prizes?* Will there be prizes?* Yes No

If there are prizes, please list them below:

Will you have a moderator assist with incoming questions or will you be working on your own? Will you have a moderator assist with incoming questions or will you be working on your own? Yes No

If there are guest speakers, please enter them in below:

Will CE be offered for this event?* Will CE be offered for this event?* Yes No

If CE is offered, please share how many credits and what kind