*Agency/Organization Name:
*First Name:
*Last Name:
*Phone Number:	(xxx) xxx-xxxx Ext:xxx
Fax Number:
*Email Address:
*Name of Event: (As it will appear on the schedule board in the lobby)
*Room Requested:	Choose One 1006 1007 1012 1039 1070 1074 1075 1089 1093 1098 2015 2019 2020 2051
*Setup for Room (Rollover Name to see photo of setup; pictures are for example purposes only.) Theater Collaboration Classroom U-Shaped Work Shop Single Work Shop Double Collaborative Closed
*Is this a weekend or after hours meeting:	Choose One No Yes
*Date room Requested:
*Times room requested: (Include Set Up times) (ex:9am-3:30pm)
*Actual meeting times: (ex:9:30am-3pm)
Alternate Contact
Alternate Contact Phone Number
Equipment
*Projector Only:	Yes No
*Projector with speakers:	Yes No
*Elmo:	Yes No
*DVD/VCR:	Yes No
*SmartBoard:	Yes No
Comments/ Special Requests:

By checking here you agree to follow all the guidelines set forth by the PSC (copy of guidelines available on request). All cancellations
need to be done with at least a 24hrs notice. Failure to do so could result in loss of your reservation fees. You are responsilbe for any and
all damage or stolen equipment in your room.