Moth Night Event Submission Form
Please fill in all fields marked with a *
  Your name *
Your email *
Your phone number *
County *
Location of event (name of site and grid reference) *
Where to meet (include directions if necessary) *
Country/region *
Date of event (dd/mm/yyyy) *
Start time *
End time
Contact phone number for public (e.g. in case the weather is bad and people want to check that the event is still taking place) *

Additional information (e.g. any charge for event, is advanced booking required, disabled access?, what should people bring to the event?)






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