Facility Request Form


 Note: Items marked with asterisk (*) are required

 NAME OF ACTIVITY*

 CAMPUS*

 SPONSOR/CONTACT PERSON*  TELEPHONE*   (Numbers only)

 EMAIL ADDRESS*  

 COMPLETE MAILING ADDRESS*  

 PERSON TO BE PRESENT & IN CHARGE OF THE EVENT*  

 EMAIL ADDRESS*    TELEPHONE*   (Numbers only)

 BEGINNING DATE*    ENDING DATE*  

 DAY(S) OF THE WEEK  

 SETUP TIME*    EVENT START TIME*    EVENT END TIME*  

 ROOM/AREA REQUIRED*    # OF PARTICIPANTS*  

 # OF TABLES*    # OF CHAIRS*    # OF PODIUMS*  

 AUDIOVISUAL NEEDS

 LCD PROJECTOR*

 PROJECTION SCREEN*

 TV/VCR*

 CD/DVD PLAYER*

 SOUND SYSTEM*

 WIRELESS HANDHELD MICROPHONE(S)*

 WIRELESS LAPEL MICROPHONE(S)*

 WIRED HANDHELD MICROPHONE(S)*

 PLEASE INDICATE SETUP REQUIREMENTS:

 

    

 Please only submit the request once.