ERA Chapter Event Services Form « Electronics Representatives Association

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ERA Chapter Services Request Form

Your event information will automatically be added to the ERA Industry and Chapter calendar after your approval.

Chapter Name *

Request submitted by *

Company *

Event Information

* Required fields are indicated with an asterisk.

Event Name *

Event Contact Name *

Event Contact Email Address *

Event Contact Telephone

Event Venue *

Venue Address/Telephone

Event Date *

Event Time(s) *

Event Description

Provide as much information about the event as possible.

Event Description *

Email Recipients

If you require marketing emails for this event, please indicate who in the ERA database should be included in the list. If you have additional email addresses to add, please email the list to Ama Derringer at aderringer@era.org.

Email recipents

ERA Chapter Members (Rep/Dist/Mfr)
ERA Chapter Non-Members (Rep/Dist/Mfr)
ALL Chapter ERA Members AND Non-members

Additional comments about who should be invited to this event? Please explain here:

Registration Form Information

If you require online registration or online registration with payment, please provide as much information about the data you want to collect from your attendees, as well as all fees associated with the event.

If you do not require registration, skip this section.

Registration data to be collected: (e.g., Name, email address, membership status, company) *

Fees to be collected: (If there are none, please state "none.") *

Additional Information

Please provide any additional information or inquiries about your email campaign/registration below.

Additional Information:

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