Event Submission Form
GROUP / ORGANIZATION INFORMATION
All information in Section A will not be published
†
SECTION A
* Denotes Required Fields
Submitter's Name
*
Group / Organization Name
*
Address
*
City
*
State / Province
--Select State--
OTHER Outside US ->
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
kansas
Kentucky
Louisana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennesee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
/
*
Zip / Postal Code
*
Phone
i.e. 800-555-1212
*
Fax
i.e. 800-555-1212
Country
*
Group / Organization Contact's Name
*
Contact Email
Group / Organization Website
*
Publish Above Information
(Section A)
--Choose One--
YES - MAY Publish Section A Info
NO - May NOT Publish Section A Info
EVENT INFORMATION
All information in Section B will be published
*******************************************************
†
SECTION B
*
Event Name
*
Event Category
Select
Event
Benefit
Fund Raiser
Night Life / Club
Conference
Seminar
Other
*
Event Type
Select
GLBTI Community Event
Community Event
Gay Men Event
Men Event
Lesbian Event
Women Event
Bisexual Event
Bisexual Mens Event
Bisexual Women’s Event
Transgender Event
Transgender FTM Event
Transgender MTF Event
Intersexed Event
Alternative Family Event
Family Event
Children’s Event
Parenting Event
GBLTI Youth Event
Youth Event
GLBTI Senior Event
Senior Event
GLBTI Cultural Event
Cultural Event
GLBTI African-American Event
African-American Event
GLBTI Latino/a Event
Latino/a Event
GLBTI Asian Event
Asian Event
GLBTI Other Cultural Event
Bear Community Event
Leather Community
PRIDE EVENT
Health Fair / Event
Mens Health Fair / Event
Women’s Health Fair / Event
AIDS / HIV Event
Cancer Event
Breast Cancer Event
Mental Illness Event
Political Event
GLBTI Democratic Event
Democratic Event
GLBTI Republican Event
Republican Event
GLBTI Green Party Event
Green Party Event
GLBTI Independent Party
Independent Party
GLBTI Other Party
Other Party
Issues and Causes Event
GLBTI Rights Event
Civil Rights Event
Domestic Partnership / Marriage Event
GLBTI Domestic Violence Event
Domestic Violence Event
Anti-Violence Event
Homelessness Event
Hate Crime Event
GLBTI Faith / Religion Event
Faith / Religion Event
GLBTI Church / Worship Service
Church / Worship Service
GLBTI Entertainment Event
Entertainment Event
GLBTI Film Screening
Film Screening
GLBTI Festival
Festival
GLBTI Music Festival
Music Festival
Mens Music Festival
Woman’s Music Festival
GLBTI Sports Event
Sports Event
Women’s Sports Event
Mens Sports Event
Tech / Computer Event
GLBTI Other Event
Other Event
Parade / March
GLBTI Parade / March
GLBTI BBQ / Picnic
BBQ / Picnic
GLBTI Social Event
Social Event
Type
*
Start Date
Month
January
February
March
April
May
June
July
August
September
October
November
December
/
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
Year
2008
2009
2010
Thru
..........
*
Ending Date
Month
Janurary
February
March
April
May
June
July
August
September
October
November
December
/
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
Year
2008
2009
2010
*
Event Location
i.e. Community Center, Club, Park etc.
*
Event City
*
State/Province
--Select State--
OTHER Outside US ->
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
kansas
Kentucky
Louisana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennesee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
/
*
Event Description:
(Max 500 Characters, no <HTML> Tags)
*
Event Contact's Name:
*
Contact's Phone:
i.e. 800-555-1212
*
Contact's Email:
Event's Website
Other Event Information / Notes
(Max 500 Characters, no <HTML> Tags)
†
Definitions
:
Section A:
Section A is for QBliss use only and will not be published to anyone outside of the QBliss organization unless the submitting organization has given express and written permission to publish said information.
Section B:
Section B is used for published events and information. Information that is submitted to QBliss in this section will be published to the appropriate parties, "newswires", and/or QBliss webpage(s) after it has been reviewed by QBliss staff. QBliss reserves the right to publish or deny publication of any events or information.