Agility New Event Submission Form
Please provide accurate event info, ensuring all info is spelled correctly.
YOUR EMAIL ADDRESS
*
example@example.com
EVENT NAME/TITLE
*
EVENT DATE
*
-
Month
-
Day
Year
Date
EVENT START TIME
*
Hour Minutes
AM
PM
AM/PM Option
EVENT END TIME
*
Hour Minutes
AM
PM
AM/PM Option
EVENT TIME ZONE
*
Central (CT)
Eastern (ET)
Pacific (PT)
Mountain (MT)
EVENT DESCRIPTION (What is your event/webinar going to be about? Please be as detailed as possible:)
*
EVENT HOST / SPONSOR
*
Agility
Carrier
Provider
Other Partner
NAME OF HOST/SPONSOR
*
EVENT LOCATION
*
In-Person
Virtual
EVENT VENUE NAME
*
EVENT VENUE ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
MAX VENUE CAPACITY
*
EVENT ATTENDEE REGISTRATION LINK
(If it's a 3rd party link, otherwise we will create link.)
IS THIS A REPEATING EVENT?
*
Yes
No
EVENT TOPIC
*
ACA
Medicare
Life
Supplemental
Compliance
General/Other
EVENT MARKETING - Check any that you need for this event:
*
Email
Social Media Ad (Paid)
Social Media Post (Free)
Other
None
If YES for Social Media Ad (Paid), what is your budget for the ad?
$200 max
$100 Max
$50 Max
$20 Max
If YES for Social Media Ad (Paid), what is your target audience (State/Zipcode)
Submit
Should be Empty: