Room Reservation Email Request Form

Room Reservation
Email Request Form

Submit this completed email form to the Instructional Media Center at the USA Library at least two weeks prior to the event. A confirmation email will be sent to the person making the request.

If all required fields (those marked with an asterisk (*)) are not completed, the form will not transmit.


*Contact Information Name
*Name of Group/Class
* Telephone	Include Area Code
*E-Mail
* Address
* City	* State * Zip

*Date of Event
*Time Requested
*Description of Event
*Room Requested	Room 181 Room 171 Room 123
*Number Expected to Attend
*Open to the Public?	Yes No
*Will Admission Be Charged	Yes No
If yes, how much?	Students Others
*Do You Intend to Bring Refreshments?	Yes No Refreshments facilities in Room 181 only; no food or drinks in other rooms
If Yes, What?
Media Needed	Internet PowerPoint Microphone DVD/VHS
Other

RESTRICTIONS

I understand that permission for use of these rooms is granted only for those specific activities listed on this request. I further understand that my organization and I will be responsible for all arrangements and for clean-up following the activity. Charges may be assessed for clean-up, security or special requests. If needed each attendee will be responsible for obtaining a temporary campus parking permit from the University Police Department: 251-461-1481

* I agree to comply with these restrictions. Please read and check the box to agree with restrictions.

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Questions at IMC@usouthal.edu or call (251) 460-7029
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Last updated: 10/11/07. kpw