New Event Request (staff use only) – VRSA

Email*

Event Type - Please select one*

Training Class
Virtual Engagement/Presentation
Member Forum/Roundtable
Workshop
Meeting

Virtual Platform for virtual events - Please select one (If not selected, the default will be Webex.)

Webex
Teams

Event Name*

Event Description*

Presenter(s) Name and Title (add company if applicable)*

Event Date*

Start Time*

:

End Time*

:

If your event requires multiple dates and times, please list them below.

Location of Event - Provide a complete address including the venue name (i.e., Blacksburg Police Department) - not necessary for virtual events

For virtual events, do you want to enable additional unregistered attendees?

If the answer is yes, then the following question will appear on the registration form: "If you plan to broadcast this virtual event to coworkers, how many additional attendees do you expect will join the event?"

Yes
No

Number of Available Seats

Food/Beverages - Please select all that apply (optional)

Refreshments Provided
Lunch Provided

Contact Name - Provide email if the contact is not a VRSA employee

This is the person who should be contacted for more information or questions about the event. This contact will be included on invitations.

Nature of Business - Check all that apply*

This information is used to select which members the invitation will be sent to.

Contact Role - For Internal Use Only - check all that apply*

Invitation Region/Territory - For Internal Use Only - check all that apply

If this is a physical event, please check all the regions/territories that should receive the invitation.

Select All
Central Virginia
Eastern Shore
Hampton Roads
Northern Virginia
Southside Virginia
Southwest Virginia
Valley
Western Central

Select all coverages needed to attend this event*

Open to All Coverages
Auto
Cyber
General Liability
LODA
Law Enforcement Liability
Property PR/IM/CR
Public Officials
Workers' Compensation

Up to three questions can be added to the registration page. The following is a default question automatically added to all registration pages: "What is one question you would like answered during the presentation?" You can add two more questions below, or you can add three questions. If you add three questions below, then the default question will be removed.

Additional Notes - Please provide any additional information - including restrictions to a specific territory, parking notes, any unusual arrangements or specifications, etc.

Training Calendar Addition Form