Campus Services Office Box 5600, Ext. 5189 RESERVATION REQUEST *This form is for facility reservations and room set-up only.   For reservations with multiple dates in the same location and at the same time please print out a paper form and send it to campus box 5600.
*Field names in this color indicate a required field.		Saturday, November 21, 2009
Date of event (please use the calendar button to choose a date)
Event title (as it is to appear on the Central calendar)
Building    Room    Size of Group
Want to know which rooms are available? Check it out
Performance or start time (hh:mm am/pm)    End Time (hh:mm am/pm)
What time do you need for:   Setup (hh:mm am/pm)     Clean up (hh:mm am/pm)
Will your group be going through the Central Market food court for a meal?   yes   no
Time (if yes, hh:mm am/pm)
Will your group be using Central Dining Services for catering?   yes   no
It is your responsibility to contact Dining Services at least one week in advance, ext. 5788, with your catering needs.
Audio/Visual equipment	microphone(s):   Lapel: Num     Corded: Num    Cordless: Num
none	LCD projector   LCD projector with speakers for audio
	(LCD and/or laptop computers must be reserved through campus services ext. 7490. You are responsible for reserving, pick up and return of equipment. Campus services hours are M-F, 8 am - 5 pm)
	laptop computer   speaker phone (digital)   overhead projector (transparencies)
	screen   TV/VCR/DVD Player   VCR/DVD Player
Additional equipment	flip chart -$5 charge per flip chart per day, with paper and markers  How Many?
	Budget Number: no dashes (if flip chart selected)     podium
none	staging - size?    piano    Fazioli piano (Douwstra only; Must be approved by Patrice Ewoldt or Mark Babcock)
	Dry Erase Board with Markers - How Many?    Easel - How Many?
	Other   Description (if Other selected)
Room setup (click to see examples of setups marked with an *)   Banquet * Block * Board Room * Circle of Chairs * Classroom * Crescent Rounds * Double Herringbone * Herringbone/Chevron Reception - no tables or chairs Round * Theatre * U-Shaped Other
Description (if Other selected as Room Setup)
Do you want your event on: calendar.central.edu (public invited)  my.central.edu (The Crier)  Both  Neither
Description for calendars (if yes, Limited to 300 characters)
Price of the event (100 characters max)
Complete URL to a page with more information about the event (Ex: http://www.central.edu/)
Department or Student Organization using facility     Email
Individual requesting facility
If you are a student, please list the name of your instructor, organization advisor, or department supervisor related to this event
Phone (Office or room extensions only please, no long distance numbers)    Box