Independence Campus Room Requisition

INDEPENDENCE CAMPUS ROOM REQUISITION
Department Name:	Date Request Submitted:
Contact Person:	Extension:
Group Name:	Function Location:
Date(s) Needed:	Time Needed:
Number Attending:
FACILITY REQUIREMENTS
Number of Tables:	Number of Chairs:
If you have a preferred set up for the room, please fax a rough sketch of the arrangement to extension 4995. Please include the Group Name, Contact Person and date the original request. Please check if you are faxing sketch
Food Requirements	Equipment Needs
Coffee/Tea Service Lunch Brought in by: Dinner Brought in by: Caterer	Video Conferencing Overhead Projector Conference Call(s) Internet Access Other Tech Support Amount of time
Special Needs/Comments