Name of Organization:
Your Title: (For all conference correspondence)
State / Province / Region
Postal / Zip Code
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?
Campus Housing or Accommodations needed?
Dining Services Café meal tickets needed?
Arrangement* (Some rooms have standard set-ups):
"Other" special arrangements:
Do you foresee any musical equipment? ($125.00 Tuning Fee for Piano):
"Other" set-up requirements: