New Event Submission form | ePlatinumHealth

Who is the presenting Agent?*

First Last

What type of event is it?*

If 'Other' please describe event below:

What day is the event?*

What time does the event start?*

: HH

MM

What time do you expect the event to end?

: HH

MM

Where is the event being held?

If the event is Virtual please go to the next question.

Street Address Address Line 2 City State ZIP Code

If the event is Virtual, please enter the details below:

Such as the meeting link, meeting ID number, meeting password, and local meeting phone number.

For example)
URL: https://usweb.zoom.us/85326147120
Call in number +1 312 626 6799 US (Chicago)
Meeting ID: 853 2614 7120
Passcode: myeph2020

What is the attendee capacity?*

Please enter a number from 1 to 400.

Anything else you'd like to say about this event?

What is your phone number?*

What is your email?*