Antioch University Los Angeles

Room Request Form

AULA Campus Services
Telephone: (310) 578-1080 x301
Fax: (310) 822-4824

Name of Requestor *

Requestor’s Phone # *

Requestor’s Email *

Requestor’s Fax#

Department *

Program

Is this event a collaboration? *	yes no

Collaboration with whom?

RSVP needed? *	yes no

RSVP to whom?

Event Title *

Expected Attendance: *

Start/Event Date

End Date

If your event will be recurring, please tell us how often		(i.e. weekly, 15th of each month, 3rd Tuesday):

Room Requested		(Use Room # if Known)

Set-up Time *

Start Time *

End Time *

Break-Down Time *

Event Type *	Open (Free & Open to All) Pre-Reg (Fee &/or Advance Registration) Closed (Invite Only)

Will You Be Serving	Food Coffee Alcohol

Please provide a short summary/time-line of your event, including set-up needs:

Please provide copy for posting on First Class & Google Calendar (100 word max):

EQUIPMENTS: Please enter the quantity of each item required.		Initial here if you don't require any equipment.

TV

VHS VCR (1/4")

DVD Player

Microphone

Stage

Lighting

Laptop (PC)

LCD Projector

Overhead Projector

Slide Projector

Projection Screen

Boom Box w/ CD

Other Equipments

800.726.8462