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 Name Are 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 Department Off Campus Organization Which Department?*(responsible for additional costs) Your Information / Contact Information / Billing InformationRequestor Name* Organization 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 SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone* Email* Besides yourself, is there a Contact Person Billing Organization Contact Name Contact PhoneContact Email Contact Address Street Address City ZIP Code Billing Organization Billing Name Billing PhoneBilling Email Billing Address Street Address City ZIP Code Sponsor Name Sponsor 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 RoomAllagash 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 RoomAllagash 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 : Hours Minutes AM PM Start time of event* : Hours Minutes AM PM Time Out*Time you wish to relinquish use of the requested facility : Hours Minutes 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 Options Special 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 eventPhoneThis field is for validation purposes and should be left unchanged.