Video Conferencing Request Form

Please provide as much information as possible.

Required fields are marked with an asterik.

Local Contact Info
Please provide your contact information
First Name: *
First Name
Last Name: *
Email Address: *
Phone Number: *
Department: *
Affiliation: *
Faculty
Staff
Student
Other
Far End Contact Info
Please provide the contact informationfor the far end of the confrenece
First Name:
First Name
Last Name:
Email Address:
Phone Number:
University or Business name:
Technical Contact?:
yes
no
not sure
Is this person the technical contact?
IP Address:
Enter the far ends IP address if you know it
Event Details
SAS Course #:
If this is realted to a SAS class please provide the course #
Date of conference : *
Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Year 2008 2009 2010
End time of conference: *
hour 1 2 3 4 5 6 7 8 9 10 11 12
:
minute 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
am
pm
Start time of conference: *
hour 1 2 3 4 5 6 7 8 9 10 11 12
:
minute 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
am
pm
Location: *
MMS Studio (Capcity: 8)
Multi-Media Resource Room  (Capcity: 2)
Other (please provide your prefered location)
Other location building:
If you selected other, please provide the building
Other location room:
If you selected other, please provide the room #
Connection Type: *
IP
Skype
iChat
ISDN
Not Sure
Other
Expected Audience size locally :
Addition Details: