Type of Event, please leave blank
Drop Off
Pick Up
Catering
Other
Organization Name (and link if available):
*
Contact Name
*
Contact phone:
*
Contact e-mail:
*
Event date:
*
-
Month
-
Day
Year
Date Picker Icon
Event start time:
*
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2
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8
9
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12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Event end time:
*
1
2
3
4
5
6
7
8
9
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12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Which street provides access to the loading dock/area?
*
Event Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Event city:
*
Estimated size of event:
*
Is the event indoors or outdoors?
*
indoors
outdoors
If indoors what floor or room
Does the building have a parking garage or onsite parking?
*
Yes
No
If no, where is the nearest parking?
Is there access to any of the following
electrical outlet
water
Link to event page (if available):
Event Special Instructions
Part 2
Please describe the mission of your organization in 2-4 sentences. How does it strive to advance diversity, equity, and inclusion?
In which of the following issue areas does your organization work?
Children and youth
Criminal justice reform
Environment
Food access and affordability
Government community relations
Health
gender
Other
Please describe your event in 2-4 sentences:
What are the desired outcome(s) of your event for the attendees and greater community?
Do you have a plan to evaluate these outcomes?
Is there anything else you would like us to know?
How did you hear about us?
Are you nonpartisan?
yes
no
Are you nonprofit?
yes
no
Submit
Should be Empty: