Business Name *

Is your organization a current E-REP member? *

Enter required value Yes No Unsure

Primary Contact Name *

Phone Number *

Email Address *

Requested Room *

Our organization offers both full-day and half-day rates, with pricing available for members and non-members.

1st Floor Media Suite (cap. 45) (minimum 20)

1st Floor Executive Dining Room (cap. 10)

2nd Floor Meeting Room (cap. 6)

5th Floor Conference Room (cap. 22)

Regional Resource Room (cap. 45)

Unsure

Date Requested *

Additional 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

Web cam

None

Billing Contact Name (if different)

Billing Email Address