Winston House: Long-Term Residency Request (one week or longer)
Space Requested:
*
LG-01 Media Room/Classroom
LG-03 Student Reading Room & Computer Lab
G-10 Classroom
101 Seminar Room
102 Seminar Room
Seminar Rooms 101 & 102
201 Faculty Office
202 Faculty Office
203 Classroom
Date(s) Requested: (mm/dd/yyy)
From:
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Month
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Day
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Hour
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Minutes
AM
PM
To:
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Month
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Day
Year
at
1
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9
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12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
Arrival Time:
Departure TIme:
Numbers of persons to occupy space:
Organization Hosting Reservation:
Contact information:
Full Name:
*
E-mail Address:
*
Phone Number (including country code if not in U.S.):
*
Fax Number:
Address:
City:
State:
ZIP Code:
Winston House is outfitted with chairs, tables, and other equipment. Please describe any special requirements you will have during your stay. If you have audio-visual needs, list them here. Be as specific as you can be.
If you would like to use Winston House at irregular times, please list them below:
I have read the Winston House Use Policy:
*
Yes
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