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For the Event Date field, please enter a single date in the format of mm/dd/yyyy. Thank you.
Organization Type: --------- Non-Profit Group Church Civic School Other
Name of Organization:
First name:
Last name:
Email:
Address:
Address2:
City:
State:
Zip:
Phone:
Contact Fax:
Tax ID Number:
Event Name:
Event Date:
Event Location:
Number of Attendees?
Event Description:
2800 Bullittsburg Church Rd. Petersburg, KY 41080 * Located seven miles west of the Cincinnati Airport