COM Request Form

1. Person Requesting

Name

Phone Number

Ticket Number

2. Event Information

Name of Event

Type of Event

Sponsoring Department

Speaker Name

High Profile Speaker?

3. Choose a Room

Preferred Room Space

Number Attending

Start Date

End Date

Event Start Time

Event End Time

Start Time for Setup

Food Served?

Alcohol Served?

4. Event Open To —

Event Open to

5. Financial Arrangements

Admission

Registration

Donations

Items for Sale

6. IT Equipment (charges may apply)

IT Equipment

Computer

Projector

Screen

Speakers

Microphone

None

7. IT Staff Needed

IT Staff

Support for web conferencing/video capture

Video capture/streaming (Echo 360)

Web conferencing (GoToMeeting, GoTo Webinar, WebEx, Zoom, Microsoft Teams)

Video conferencing equipment (Polycom)

IT Staff needed during event (Charges may apply)

None

Additional notes for IT Staff

8. Billing Arrangements

Send Bill To

UC Flex Number

* UC Sponsored Organizations Must Supply UCFLEX Number

Comments/Additional Dates/Special Instructions

Terms and Conditions

Do you Agree with the Terms and Conditions

I accept the Terms and Conditions