Name of Organization:

First Name:

Last Name:

Your Title: (For all conference correspondence)

Mailing Address:

City:

State:

Zip Code:

Phone:

Email:

Person Responsible for Financial Obligation:

Reservation Start Date/Time:

Reservation End Date/Time:

Event Title:

Description of Activity:

Expected number of attendees:

Is your group a non-profit 501(c)(3) organization?

Requested Room if Available:

Any anticipated ticket/retail/vendor sales?

Request for alcohol present during event?

Catering needed? 

Campus Housing or Accommodations needed?

Dining Services Café meal tickets needed?

Arrangement* (Some rooms have standard set-ups):

Set-up Requests:

Use of piano needed? ($125.00 Tuning Fee):

Other requirements?