Requested By*
Contact Name (if different)
Contact Phone*
Contact Dept/Organization*
Contact E-Mail Address*

Event Semester*
Fall
Spring
Summer

Event Title/Type*

Expected Attendance*

Will people from off-campus be attending this event?*
Yes No

Event Date(s):
Start Date (mm/dd/yyyy)*
End Date (mm/dd/yyyy)*

Event Time (24 hr clock):
Start Time: HOUR 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 MIN 00 10 40 *
End Time: HOUR 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 MIN 00 30 *

Is AV equipment needed?*
Yes No

Seating Preference:*
Choose Seating FIXED MOVEABLE NO PREFERENCE

Room Preference:
First Choice*
Building: Room:

Second Choice*
Building: Room:

If first or second choice room preference is not available, may we substitute a comparable room? Yes No

Additional comments?

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