Conferencing - University Event / Room Request Form

University Event / Room Request Form
Name of Requestor*

First NameLast Name
Contact Number

Area CodePhone Number
Email*
example@example.com
Department Name*
Department Contact Number*

Area CodePhone Number
Department Org#
Is this event for Southern Connecticut Dept or Organization*

YesNo
Event Name*
Event Description*
Facility*
Provide Room Numbers, Name or Location*
eg, 201, Seminar Room, C112
Number of Attendees
Preferred Dates*
Please add list of dates for your event
Start time for each day

:HourMinutesAM/PM Option
End time for each day

:HourMinutesAM/PM Option
Is this event open to the public?*

YesNo
Is there admission or registration?*

YesNo
Is alcohol being served? (if yes, please complete Alcohol Request Form for on-campus events here*

YesNo
Please click on Alcohol Request Form
Do you require catering? (If yes, click here to view menu and pricing.)*

YesNo
Please click on Catering Menu and Prices
Is Shuttle Service Required (if yes, please click on the link below)*

YesNo
Please click on Chartered Shuttle Service
Do you require the use of Audio Visual Technologies*

YesNo
Please specify type of Audio Visual Technologies Requested
Requestor Print Name
Requestor Signature

Clear
Disclosure: As requestor for the above organization, I affirm that I am familiar with and agree to abide by the policies governing the use of University facilities. I also agree to accept responsibility for any damages, loss or theft of University equipment and property, including all charges incurred

To accept please check box
Should be Empty: