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Facilities Reservation Request
Instructions:
Please indicate your facilities request by completing all applicable elements of the form below. At the bottom of the form are instructions and a button for submitting your completed request.
 Requestor Information
Organization Name:
Contact First Name:    Last Name: 
Address:
City:    State:    Zip: 
Telephone:    Fax: 
Email Address:
Group Type: Campus    For-profit Org.    Non-profit Org.    UW-affiliated
 Event Information
Name of Event:
Type of Event:
# of attendees:
Will attendees be charged an admission or registration fee?  Yes  No
If a fee will be charged, what will be the fee amount?   
 Room Selection
First Room Choice: Second Room Choice:
   Click here to review applicable room, equipment, and personnel fees.
 Date/Time Selection
 First Choice
Start Date: End Date:
Start Time: Stop Time:
 Second Choice
Start Date: End Date:
Start Time: Stop Time:
 Third Choice
Start Date: End Date:
Start Time: Stop Time:
 Equipment Selection
Computer LCD Projector VCR Blackboard/Whiteboard
DVD Player Document Camera Lectern/Mic Transparency Projector
Upright Piano Grand Piano Slide Projector
Screen Only (A screen request is assumed for any projection equipment selected above.)
Chair Quantity Table Quantity Music Stand Quantity
Choral Riser Quantity Choral Shell Quantity
   Click here to review applicable equipment fees.
 Food/Beverage Services
Do you require food and/or beverage service?
Yes If yes, please contact Laurie Allen (608-647-6186x253) to make arrangements.
No
Will alcoholic beverages be served?
Yes If yes, UW-System guidelines require approval of Dean, as well as other restrictions.
No See Policies and Procedures below for detailed guidelines and restrictions.
 Room Setup
Lecture Format >>Show me this setup
Classroom >>Show me this setup
Herring Bone Classroom >>Show me this setup
Open Square >>Show me this setup
Open "U" >>Show me this setup
Banquet with Round Tables >>Show me this setup
Banquet with Square Tables >>Show me this setup
 Comments/Special Notes
Enter any comments or notes below:
 Complete Your Request
To complete your request, please read the Policies and Procedures below. If you accept the policy conditions and have completed all application sections above, then click on the consent checkbox (immediately below) and click the "Submit Request" button.
 On behalf of the organization I represent, I assume responsibility for the use of the facility in accordance with the University of Wisconsin - Richland Facility Use Policies and Procedures as presented below.