Event Request Form | The Ehlers Danlos Society : The Ehlers Danlos Society

Event Request Form

Event Name*
Event Date*
Event Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Event Description*
(max 2000 characters)
Event Type*
- Awareness
- Conference
- Fundraiser
- Service
- Social
Number of attendees expected*
Sponsoring Group/Organization
Primary Contact Name*
First Last
Organization Name*
Contact Email*
Contact Phone
Email for inquiries/questions*
Event Registration/Reservations/Ticket information
Website
Event/Organization logo
PLEASE NOTE: The Ehlers-Danlos Society can only promote and/or supply t-shirts to fundraising events where the funds are going to support The Ehlers-Danlos Society.
Is this an Affiliate Event?
- Yes
- No
Affiliate Name
If it is an Affiliate Event, please tell us the name of the Affiliate here.
Public Release
- Yes
- No
By choosing yes, you acknowledge that the information you have provided will, pending Society approval, be listed publicly. If you have questions, please contact Carissa Hocevar.
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