New Customer Registration Form

1

Full Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

What is the name of the event?* This field is required.

4

What department or committee is the event linked to?* This field is required.

5

What is the date of the event? * This field is required.

Date

6

What is the purpose of this event? Describe a brief overview of the intent and how it relates to the school’s mission. * This field is required.

7

What is the preferred building location and room number? (refer to room reservation system for availability)* This field is required.

8

What is the name and title of the LSUHSC SAHP requestor/organizer? (this is the person the administration team assisting will have to coordinate any questions about the event with)* This field is required.

9

List type of attendees. (ie. Faculty, Students, Staff, Non LSUHSC)* This field is required.

10

What is the number of invited guests?

11

What is the estimated number of attendees?

12

How long is the event? (1 hours, 2 hours..)

13

What is the total estimated cost for hosting the event? (include all anticipated expenses - food, drinks, facilities, security, parking, swag, etc)

15

If alcohol is served there should be a LA certified server and an authorization to serve alcohol form should be signed and submitted. University police will also need to be present. Is this understood by requestor?* This field is required.

YESNO

16

Will alcohol be served at the event? (If alcohol is served, ensure food and non alcoholic drinks are available) * This field is required.

YESNO

17

Are there exchange of funds for any of the options below?

Vendors

Guest speakers

Servers

On Campus Services (overtime facilities, parking, security)

Other

18

Provide a brief overview of the need for the exchange of funds. This is so that the administration team understands what's needed fiscally.

19

Additional comments or notes about event.