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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 Quanti