Name of Organization:

Requestor ID Number:

Contact Person:

Your Title (for all conference correspondence):

Contact Email:

Contact Phone:

Mailing Address:

City:

State:

ZIP Code:

Person responsible for financial obligation:

Description of program or activity:

Reservation From Date/Time:

Reservation To Date/Time:

Number of rooms needed:

Expected number of attendees:

Any anticipated ticket/retail/vendor sales?

Is your group nonprofit?

Catering?

Request for alcohol present during the event?

Audio/visual requirements?

Setups and Events (may have multiple entries):

Other set-up requests:

Other Requirements:

Southwestern Oregon Community College does not discriminate on the basis of race, color, gender, sexual orientation, marital status, religion, national origin, age, disability status, or protected veterans in employment, education, or activities as set forth in compliance with federal and state statutes and regulations.