Facilities Request Form View the Conferences & Special Programs Room Availability Calendar NOTE: The calendar can be filtered by room by using the small down arrow icon at the top-right corner of the calendar page. Are you an on-campus or off-campus entity?*On-CampusOff-CampusIs this for a student organization?*YesNoDepartment or Student Organization NameAre you requesting Wieden Auditorium?*NoYesSponsored event?*NoYesHas this event been approved by an on-campus sponsor?*YesNoNOTE: There is a $2.00 per person fee for sponsored events.Are UMPI Students participating in this event?*YesNoWho is responsible for any additional costs?*UMPI DepartmentOff Campus OrganizationWhich Department?*(responsible for additional costs)Your Information / Contact Information / Billing InformationRequestor Name*Address*Enter your mailing address or campus mailbox. If you're a student, enter an address where we can send a confirmation. Street Address City ZIP Code Mailing Address* Street Address City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Email* Besides yourself, is there a Contact Person Billing Organization Contact NameContact PhoneContact Email Contact Address Street Address City ZIP Code Billing OrganizationBilling NameBilling PhoneBilling Email Billing Address Street Address City ZIP Code Sponsor NameSponsor Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Event InformationEvent Title*Event Description*Description of your planned use of the facility. In the case of a performance or presentation, please be specific about the title, groups or individuals being presented. When available, ticket prices should be included since this information will be included in the University calendar.Event DescriptionDescription of your planned use of the facilityRoom Options*Please check the room that you would like to reserve. Only if date and time are available after approval process will you be guaranteed your room reservation. See more information about the available facilities. View Facilities Fees list I have no preferenceMulti-Purpose RoomSt. John RoomAroostook RoomAlagash RoomAlumni RoomCC112 RoomCC118 RoomOwl's NestRoom Options*Please check the room that you would like to reserve. Only if date and time are available after approval process will you be guaranteed your room reservation. See more information about the available facilities. View Facilities Fees list I have no preferenceMulti-Purpose RoomSt. John RoomAroostook RoomAlagash RoomAlumni RoomCC112 RoomCC118 RoomOwl's NestWieden AuditoriumDay(s) and Date(s) of event*Please include day and date (i.e., Tuesday, January 10, 2017). This form may be used to reserve several days at one time provided that the use is for the same purpose and time each day. CONTINUOUS REQUESTS: Please let us know if you will meet during school breaks. View the Conferences & Special Programs Room Availability CalendarTime In*Time you wish to enter the facility : HH MM AM PM Start time of event* : HH MM AM PM Time Out*Time you wish to relinquish use of the requested facility : HH MM AM PM Who may attend?Anticipated Attendance*The number of people you are expecting to attend or to participate at your event. Please be as accurate as possible.Special Accommodations / Setup Instructions / Requirements / PublicityPlease check any that apply Audio / Visual / Technology Needs Food Service IT Options Laptop Projector/Screen Wifi Podium Sound (of any kind) Microphone Wireless Lapel Other Other IT OptionsSpecial AccommodationsIf any of your attendees require special accommodation, please describe here.Special setup for Facilities ManagementIf you need special setup for Facilities Management, please describe here.Computer Accounts After this form is submitted, you will be given a link to a form to request non-academic computer accounts.Please outline what you would like for for Food Service below, or contact Lydia at 768-9502 / firstname.lastname@example.orgFood Service Details*List event in the Image?*Would you like to list your event in the Image Newsletter?NoYesMeeting Layout Options*Round Tables can not be set up in rooms CC112 or CC118. The Alumni Room layout is Hollow Rectangle and cannot be changed. *please note, room diagrams are not drawn to scale*"U" Shape StyleRound Table (Seats 6-8 each)Classroom Style"T" Shape StyleFamily Style DiningHollow Rectangle"E" Shape StyleOctagon Meeting StyleBoard Room StyleJust ChairsOther (Please describe below)Additional comments we should take note of regarding details for your eventEmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.