COMMUNITY EVENT SUBMISSION<form method="post" action="http://www.emailmeform.com/fid.php?formid=94430" enctype="multipart/form-data" accept-charset="UTF-8">
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<font face="Verdana" size="2" color="#dadada">To submit your event, complete the information below and be as detailed as possible.  Click submit and confirm your event information and allow 24 hours for PFLAG to review and post your event to the events calendar and listserv.</font>
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 <td nowrap><font face="Verdana" size="2" color="#dadada">Event Name</font></td>
 <td><input type="text" name="FieldData0" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#dadada">Start Date</font></td>
 <td><input type="text" name="FieldData1" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#dadada">Start Time</font></td>
 <td><input type="text" name="FieldData2" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#dadada">End Date</font></td>
 <td><input type="text" name="FieldData3" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#dadada">End Time</font></td>
 <td><input type="text" name="FieldData4" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#dadada">Event Descripition</font></td>
 <td><textarea name="FieldData5" cols="60" rows="10"></textarea><br> </td>
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 <td nowrap><font face="Verdana" size="2" color="#dadada">Event Website</font></td>
 <td><input type="text" name="FieldData6" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#dadada">Website Extension</font></td>
 <td><select name="FieldData7"><option value="COM">COM</option><option value="NET">NET</option><option value="ORG">ORG</option><option value="BIZ">BIZ</option><option value="INFO">INFO</option><option value="US">US</option><option value="MOBI">MOBI</option><option value="GOV">GOV</option><option value=""></option></select> </td>
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 <td nowrap><font face="Verdana" size="2" color="#dadada">Contact Name</font></td>
 <td><input type="text" name="FieldData8" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#dadada">Contact Email</font></td>
 <td><input type="text" name="FieldData9" size="60"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#dadada">Contact Phone</font></td>
 <td><input type="text" name="FieldData10" size="60"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#dadada">Press Attachments (PDF, DOC)</font></td>
 <td><input type="file" name="FieldData11" value="" size="60"> </td>
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<td class="label" colspan="2"><font color="#FFFFFF" face="Verdana" size="2"><b>Image Verification</b></font></td>
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<td class="captcha" style="padding: 2px;" width="10"><img src="http://www.emailmeform.com/turing.php" id="captcha" alt="captcha"></td>
<td class="field" valign="top"><div><font color="#000000">Please enter the text from the image</font>:<br><input type="text" name="Turing" value="" maxlength="100" size="10">
 [ <a href="#" onclick=" document.getElementById('captcha').src = document.getElementById('captcha').src + '?' + (new Date()).getMilliseconds()">Refresh Image</a> ] [ <a href="http://www.emailmeform.com/?v=turing&amp;pt=popup" onClick="window.open('http://www.emailmeform.com/?v=turing&amp;pt=popup','_blank','width=400, height=500, left=' + (screen.width-450) + ', top=100');return false;">What's This?</a> ]</div>
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<input type="text" name="hida2" value="" maxlength="100" size="3" style="display : none;">
<input type="submit" class="btn" value="Send email" name="Submit">&nbsp; &nbsp; <input type="reset" class="btn" value="  RESET  " name="Clear"></td>
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</form>NOTE:  Additional documentation (PDF, DOC) can be emailed to the communication specialist asperling@pflagtriangle.org with your Event Name as the Subject.