ACC Event Form

Name:		Phone:
Dept:		Email:

Date of Event:

Title of Event:

Start Time of Event:

End Time of Event:

Please check the following which describe the purpose of your event: (check all that apply)

Who will your audience be? (check all that apply)

Students	Public
Faculty/Staff	Other:

Where will the event be held?

How many people do you plan will attend at one time?
1 - 15
15 - 30
30 - 40
40+

What type of equipment will you need for this event?

This form is submitted to John R. Kennie, Video Support Services Manager.