FACILITIES RESERVATION & SERVICES ORDER FORM

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1 Today's Date: Event Date: Event Name: Event Time: Start: AM PM End: AM PM Company Name or Department: Company/Department Address: Number of Attendees: Requesting Method of Payment *Dept Budget Check Credit Card Other *Dept Budget # must be provided in order for request to be processed Contact Name: Contact Contact Phone: Contact Fax: External Internal Commercial Non-Profit Facilities (please check the box) *room assignment dependent upon availability. Auditorium/Foyer, (capacity: 220 Theatre, 140 Classroom) indicate number of days: CTC Seminar A, (capacity:65 Theatre, 40 Classroom) indicate number of days: CTC Seminar B, (capacity: 85 Theatre, 82 Classroom) indicate number of days: CTC Seminar C, (capacity: 35 Theatre, 22 Classroom) indicate number of days:: Setup/Breakdown Required: (please check the box) Theatre style: chairs only Classroom style: chairs and tables in rows Board style: chairs and tables in square Forum style: chairs and tables in open "u Conference style: rows of tables w/ chairs on 2 sides Cluster style:tables in groups w/ chairs on all sides Banquet style: round tables w/ chairs around table Crescent style: round tables w/ chairs in semi-circle

2 Equipment Required (please check the box) Plasma Screen (Lobby) Laptop Small Podium TV with DVD /VCR Combo LCD projector Projection screen Protective carpet mat *mandatory for catering Overhead Projector Easel Easel Pads Flip Charts: Markers: QTY QTY Auditorium only 8ft tables indicate number up to 20: 6ft tables indicate number up to 20: round round Chairs indicate number up to:200 Large podium with plasma screen monitor *required for powerpoint presentation Sound System with standard microphones Sound System with wireless microphones Other Equipment and / or Services (please check the box) Video recording CTC Rooms only Telephone *CTC Seminar A, B & C Only Event Management *payment may be required for some evenings and weekends Housekeeping *required for catering :minimum 4 hours Technology Consultation (required with technical and / or AV system use; minimum 4 regular hours) Satellite Conferencing Video Conferencing Bridging Services Video Conferencing International Long Distance Video Conferencing Domestic Long Distance Security Coordination (at clients expense) Parking Coordination Signage Coordination (must provide all signage at clients expense)

3 Client Budget Information: Budget No. Fund Dept. I.D. Acct. Prog. Class Print name of requestor Signature of requestor Signature - Budget Authority For Accounting Use Only: TRAN F BATCH NO. FY DOC. DATE / / 3102 LTC $ DR/CR C Fund Dept I.D. Acct Prog Class Reviewd by: DISTRIBUTION OF COPIES (1) Building Operations, (2) Business Office, (3) Originator Approved by: I acknowledge completion of this reservation form and understand that any changes must be made by completing a change order form. Changes not made within 5 days of the reservation will incur change order fees. Initial Cancellation must be made within 5 days or a $100 fee will be accessed. All internal events that require setup, maintenance, audiovisual and/or event management will be charged standard overtime fees after regular business hours. All copies needed must be made by the staff member hosting the event and must have their code entered into the copier code: Client Signature: Conference Services Staff Date Entered Reservation #

4 Storage Storage

5 Rev. 06/2015 Seminar C

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