Business Name *

Is your organization a current E-REP member? *

Enter required value Yes No

Primary Contact Name *

Phone Number *

Email Address *

Requested Room *

Media Suite (cap. 45)

Executive Dining Room (cap. 12)

2nd Floor Meeting Room (cap. 6)

5th Floor Conference Room (cap. 22)

Unsure

Date Requested *

Additional and/or Alternate Dates

Please list any additional dates if needing multiple days. Also include any alternate dates in the case the requested is unavailable.

Start Time *

End Time *

Requested Access Time for Setup *

If no early access required, type "None."

Expected Number of Attendees *

Will food or beverages be served? *

Enter required value Yes No

Do you need technology? *

TV

Desktop computer

Web cam

None

Billing Contact Name (if different)

Billing Email Address