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2. Event Name
3. Is this event being hosted by a registered charity or not-for-profit organization?

   1. Yes

   1. No
5. If yes, please provide the name of the registered charity or not-for-profit organization.
7. Description

   The primary purpose of the event should be for entertainment and cannot be based on the sale of products or services. Preference is given for free events taking place within the City of Coquitlam.

9. Start Date & Time
   Start Date & Time

   Start Date & Time
10. End Date & Time
    End Date & Time

    End Date & Time
12. Event Address*
14. City*
    Events must take place in Coquitlam.
15. State*
16. Zip Code*
18. Event Contact Information
    Please note the information in this section will be displayed online.
20. First Name
21. Last Name
23. Email*
24. Phone Number
25. Website
27. Additional Information

    Please include any additional information (e.g. price, parking, etc.).

Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field