New Event Submission Form - EPlatinum Health Insurance Agency

Who is the presenting Agent?*
First Last
What type of event is it?*
If 'Other' please describe event below:
What day is the event?*
MM slash DD slash YYYY
What time does the event start?*

: Hours

Minutes

AM/PM
What time do you expect the event to end?

: Hours

Minutes

AM/PM
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?*