Landsbaum Reservation Requisition

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Q1. LANDSBAUM RESERVATION REQUISITION

Please complete the questions to request space at Landsbaum Center.

*Please note if a question is skipped, it will prompt you upon submitting they are missing, but you can continue to submit; however some questions are required to be answered, i.e. event title and date. Thank you!

Questions? Contact Cindi at 812-237-7609 or cindi.marietta@indstate.edu

Q2. Group/Organization Name

Q3. Event Coordinator Name (contact)

Q4. Event Coordinator Address/Department (if Owner)

Q5. Event Coordinator (contact) Phone Number

Q6. Event Coordinator (contact) Email

Q7. Event Name (for Signage Purposes)

Q8. Please give a brief description of your event/program:

Q9. Date(s) of Event

Q10. Times Requested for Room (start/end) - THIS includes set-up/tear-down time

Q11. Actual Program Start/End Times (for signage purposes notifying attendees)

Q12. Number of participants expected

Q13. Room(s) Requested (list all needed please)

Auditorium
Classroom 2
Classroom 3
Conference Room A
Conference Room B
Conference Room C
Conference Room D
Conference Room E
Conference Room F
Simulation Debriefing Conference Room
Hallway
Center Atrium/Rotunda
Clinic - list how many and which exam rooms needed
Clinic Waiting Room
Other

Q14. Alternate Room, if first request not available

Q15. Seating Configuration/Layout (No change available for Classroom 1 or Auditorium) i.e. Classroom style, u-shape, square, learning squares/rounds, etc.

Auditorium/Classroom/Lecture Style
U-shape
Square
Learning Squares
Rounds (Classroom 2 or hallway only)
Other Add add'l layout for add'l rooms here

Q16.

Audio-Visual Equipment (choose all needed)

Computer
HDMI or VGA for personal device
Microphone - lapel
Microphone - handheld
Document Camera/ELMO
Other
None

Q17. Tables Needed, other than for attendee seating,

i.e. vendors, catering, information, registration, etc.:

Size, Number and Location (use text box)

4' - How Many?
6' - How many?
8' - How many?
Rounds (Classroom 2 and West Hallway ONLY) - How many?
None
Add'l Notes

Q18. Special Requests, if any

Q19. Will you have food catered / brought in for this event? We can supply catering list by request, but anyone may cater your event. Please provide name of caterer once secured.

Q20. Any additional information you would like to add not covered in questions.