National Moth Week - July 22-30, 2017 Registration

Please enter information about your National Moth Week event in the form below.
Information entered under 'Your Contact Information' is for NMW use only.
Information under 'Event Information' will be published on the map.
Thank you for your participation. For questions about this form, send email to info@nationalmothweek.org
Public or Private Event
First Name
Your answer
Last name
Your answer
Your Contact Information - for NMW use only
For private and public events, please enter contact information for event organizer or the primary contact person for your event. This information is for NMW use only and will not be published.
PUBLIC CONTACT INFORMATION WILL BE ENTERED LATER ON THIS FORM.
E-mail
Please make sure your email address is spelled correctly. The form will accept only addressed in the form myname@email.xxx
Your answer
Telephone number
Outside the U.S., please include country code.
Your answer
Event information - for the NMW map
Information you provide below will be published on the map to show where NMW events are taking place around the world.
If your mothing is private you may omit personal addresses, phone numbers, and/or email addresses from this section that you do not wish to have published.
Country
Chose your country from the drop-down menu below
STATE - For USA registrations only!
Chose your state or territory from the drop-down menu below.
Do not answer if you are outside the USA.
State
Town
Your answer
County or Province
Your answer
Address
A street address is optional, but will help people find your public event.
Your answer
Sponsoring organization
Leave blank if your event is private or is not sponsored
Your answer
Other location information
ie: Park / Nature Center / School / Museum...
Your answer
GPS Coordinates
Optional.To find your coordinates, Google your location on Google Maps, right-click on the location marker and choose "what's here?"
Your answer
Website
Leave blank if your event is private or does not have a website.
Your answer
Public email address
Leave blank if your event is private or does not have an email address. Please make sure your email address is spelled correctly. The form will accept only addressed in the form myname@email.xxx
Your answer
Public phone number
Leave blank if your event is private or does not have a phone number.
Your answer
Event Date(s)
Public Event NOT during National Moth Week
If you plan a Public mothing event at any time NOT during NMW, enter the date here. Your event will be added to the map with a gray marker.
MM
/
DD
/
YYYY
About your event
Please provide a BRIEF DESCRIPTION (under 100 words) of what you'll be doing at your NMW event. This information will be published on the map. Click 'SUBMIT' when you finish entering your event information.
Your answer
Submit
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