Type of Request: Seminar Room General Room Lecture Hall

Requested Date: (through).

If weekly series request, please select day: once Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Type of Event: Meeting Class Recitation Screening Exam Other (specify):

Title of Event:

Estimated Attendance:

Admittance: General Public UR Private

Preferred Classroom: none B&L 109 B&L 170 B&L 269 B&L 270 B&L 315 B&L 405 B&L 416 Dewey 4-162 Gavett 124 Gavett 208 Gavett 301 Gavett 310 Gavett 312 Harkness 115 Harkness 210 Hutchison 138 Hutchison 339 Hutchison 473 Hylan 101 Hylan 102 Hylan 105 Hylan 201 Hylan 202 Hylan 203 Hylan 206 Hylan 306 Hylan 307 Hylan 618 Lattimore 203 Lattimore 212 Lattimore 413 Lattimore 431 Lattimore 513 Meliora 169 Meliora 178 Meliora 204 Meliora 205 Meliora 206 Meliora 208 Meliora 209 Meliora 218 Meliora 219 Meliora 221 Meliora 223 Meliora 224 Meliora 418 Morey 205 Morey 401 Morey 402 Morey 501 Morey 502 Morey 503 Morey 505 Morey 506 Morey 524 Morey 525 Rush Rhees 370 Rush Rhees 424

Event Time:

Reservation Times Start: End:

Sponsor (name of student group, etc):

Sponsor's Campus Address:

Your Name:

Your Address:

Your e-mail Address:

Your Phone Number:

Persons(s) Responsible for Event:

Their Phone Number:

If all of this information is correct, you may submit this form now, or clear it and start again.