Events Form Banned Books Week Events Please complete this questionnaire to have your Banned Books Week event included on the Banned Books Week website! OK Question Title * 1. Name of Venue / Event OK Question Title * 2. Street Address OK Question Title * 3. City OK Question Title * 4. State AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Online (please specify URL) OK Question Title * 5. Zip OK Question Title * 6. Date of Event (if applicable) Date / Time Date OK Question Title * 7. Time of Event (if applicable) Date / Time Time AM/PM - AM PM OK Question Title * 8. Contact Person OK Question Title * 9. Phone OK Question Title * 10. E-Mail OK Question Title * 11. Website OK Question Title * 12. Type of Event (check all that apply) Display Reading Performance Panel Author / Artist Visit Guest Speaker Lecture Webinar Other (please specify) OK Question Title * 13. Please provide a brief description of your event. OK Question Title * 14. Is it OK to share contact information publicly with the event listing? Yes E-Mail only Phone only Please do not share contact information. Other (please specify) OK DONE