Event Information

Date of the Event:

(e.g. October 30, 2005)

Day of the week:

-- Select Day -- Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Name of Dept/Organization:

Title of Function:

Contact Information Contact Person:

Director/Sponsor:

E-mail:

Telephone: Fax:

Additional Information

Describe Cultural Relevance, if any:

Set up Date and Time:

Event Start Time:

*Note: No Setups before 8:00 AM

Event End Time:

Time needed for breakdown:

Estimated Number in Attendance:

Equipment Information

*Your Request will not be processed without the information below completed.

Room Selection (See Diagram): -- Select Rooms -- 109 A (Garden view - lecture style seats 40) 109 B (Lecture style seats 40) 109 A & B (Full room lecture seats 100) 109 A, B & Lobby (Kitchen included) 109 Conference Room (Seats 6) Computer Lab Lobby

**Note: Kitchen included with AB&Lobby but optional with others. If you desire the kitchen, please include it in the setup notes below.**

Desired Room Layout: -- Select Layout Type -- Clear/Empty As-Is (Self setup) Chairs - Lecutre style Chairs - Semi-circle Chairs - 'U' shape Tables/Chairs - 'U' shape Tables/Chairs - 6' Both sides Tables/Chairs - 6' one side Tables/Chairs - Classroom style Tables/Chairs - Conference tables Tables/Chairs - Hollow square Custom layout - Indicate below in 'Additional Notes Box'

If requesting room A and/or B, Please check the item(s) desired and fill in quantity where applicable.(Room layout and equipment only applies to room(s) A & B)
Item(s) Requested	Select Quantity
Chairs
Tables	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Computer Speakers	0 1 2
Easels (Flip charts not provided)	0 1 2
Extention Cords	0 1 2
Projection Screens	0 1 2
Television
VCR
DVD Player
Podium
Pillows/Blankets
Kitchen
CD Player/Stereo
Piano
Sound System/Microphone

By submitting this form, I agree that I have read a copy of the CME’s Reservation Policies and Procedures and agree to abide by them. As an authorized representative of the aforementioned organization, I agree to assume full responsibility for the cleanliness of the space used and for any damages that may occur. I also realize failure to comply with the CME Policy for Facility Usage may result in the loss of reservation privileges in the future.

  I agree to these terms and conditions.