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Basic Info

Todays Date*

Requestor's Name*

Are you currently a voting or above member of the LA&M?

Yes

No

Requestor's Phone*

Requestor's Email*

Event Title

Event Type*

Meeting/Discussions (up to 25 people)

Meeting/Discussions (26+ people)

Event/Contest

Reception/Gathering

Will you be the main person planning this event?*

Yes

No

Event Description & Purpose

Please provide a description of this event:*

Will money be collected for and/or at this event?*

Yes

No

Expected Attendance*

Event Schedule

Single Day or Multi-Day Event?*

Single Day

Multi-Day

Proposed Event Date(s)/Time(s)*

If this is a Multi-Day Event Please provide dates and times for your event.

Event Resources

Some items requested may be subject to availability & feasibility.

Audio/Visual Requests, please select all that apply:

Speaker needing a microphone

Wireless microphones

Powerpoint or Keynote

Pre-Recorded Music Video/Slide show

DVD Player

Equipment requests, please select all that apply.

Chairs

Tables

Use of Lobby Counter

Others

Please provide additional notes & quantities needed for requested items:

Catered food and/or non-alcoholic beverages will be served?*

Yes

No

Will alcohol be served at this event?*

Yes

No