Contact Name/Program Organizer
Title of Event
Must be descriptive and complete. (e.g. "Enola Gay: The Rise of Militant AIDS Activism" vs. "Enola Gay")
Preferred Date of Event
Name(s) of additional presenters, if any
Type of Event
Author/Artist Talk or Reading
(e.g. seniors, youth, queer, allies, trans people, etc.)
Brief description of program for publication/promotional purposes, including presenter names:
Maximum 150 words, any additional links and biographies may be sent upon event confirmation.
Image to be used for promotional/publicity purposes:
Limit to 1-2 images, please. JPEG format, minimum resolution of 300 dpi and minimum dimensions of 4" x 3"; (1200 pixels x 900 pixels). No headshots/individual photos for panels with multiple speakers.
Brief description of event structure (e.g. 30 minutes reading/discussion, followed by audience Q&A and book signing)
Audio/Visual support needed from the Museum (must be PC compatible)
Projector for screening or slideshow
Microphone and portable speaker
DVD player for screening film/clips
Layout/furniture resources needed from the Museum
Cocktail table & chairs (for 1-2 speakers in conversation)
Table(s) for panelists
Table(s) for book signing/sales
Ice buckets for wine reception (must provide
Any additional resources you wish to request from the Museum:
Items (if any) you will bring to the Museum:
(e.g., books, your own tables and chairs, minimal décor,instruments, speakers, microphones)
Have you presented at the GLBTHS previously? If so, what and when?
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm