Facility Request Form
Inquiry Date: Example: January 01, 2004
Date(s) Requested: Example: January 01 - January 30, 2004
Name of Event:
Contact Person: First Name: Last Name: Department: Name of Organization:
Street Address 1:
Street Address 2:
City: State or Province:
Zip or Postal Code: County:
Telephone: (H): (W):
Email: Fax:
Type of Event: Lecture Meeting Workshop Dinner Wedding Reception Other
Event Start Time: Event End Time: Please be sure to indicate a.m. or p.m.
No. of Attendees:
Type of Audience: Public Private Campus
Facilities Needed: Auditorium Pit Paul Gallery HC Lobby Gates Tower Gym Pavilion Ampitheater Halliehurst Madden Center Community Room Graceland: Parlor Library Dining Room Conservatory Office Conference Center: Room 207 Room A Room B Science Center: Room 400 Room 413 Room 317 Room 318 Room 319 Room 218 Room 219 Room 103 Room 104
Services Needed: A/V Equipment: Residence Halls: Housekeeping: Linen:
Comments: