| Organization |
____________________________________________________________________ |
| Contact Name |
____________________________________________________________________ |
| Address |
____________________________________________________________________ |
| Phone |
____________________________________________________________________ |
|
| Fax |
____________________________________________________________________ |
| Email |
____________________________________________________________________ |
| Request
Use: |
| Day, Date, Time: |
__________________________________________ |
| Purpose |
__________________________________________ |
| Estimated # of
Attendees |
__________________________________________ |
|
| Catering
Required |
| Light Refreshments |
__________________________________________ |
| Meal |
__________________________________________ |
| None |
__________________________________________ |
|
|
Presentation Requirements: |
Indicate what you are
providing and what you would like EACC to provide:
|
SELF |
EACC |
|
Whiteboard & Markers |
_____ |
_____ |
| Screen |
_____ |
_____ |
| Overhead
Projector |
_____ |
_____ |
| Flip Chart Paper ($10
fee) |
_____ |
_____ |
|
|
| Payment*: |
for office use only
Cash __________
Check __________ Charge __________
Credit Card
No./Expiration Date __________________________________________ |
| Entered
in Calendar: |
Date __________
Time __________ Initial __________
Copies To:
__________________________________________ |
|
Cancelled: |
Date __________
Time __________ Initial __________
Copies To:
__________________________________________
Method: Phone
__________ Fax __________ Email __________ Office Visit __________ |
| Confirmation Copies to: |
Renter_______Date_____________Building Manager_______Date___________ |
