Activity/Event and Building Request Form This request must be submitted a minimum of ten (10) days prior to the event for approval. All events require a hand-sketched or computer-generated layout at the time the activity request is submitted. Name of Requestor Class/Organization* Event Contact Person* First Last Conact Person Position/Title Contact Person Phone*Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Advisor* Advisor Phone*Requested Venue*Please Select A VenueAggrey Student UnionAggrey Student Union | PavilionEvent & Hospitality Center | Monroe St.Front LawnHilliard RoomHospitality Management & Culinary Arts Center | Jake Alexander BlvdHarriett Tubman Building | ClassroomJ.C. Price Building | ClassroomPoet's & Dreamer's GardenTubman Little TheaterVarick Auditorium | Main AuditoriumVarick Auditorium | ClassroomWiley Lash RoomSecondary Location*Please Select A VenueAggrey Student UnionAggrey Student Union | PavilionEvent & Hospitality Center | Monroe St.Front LawnHilliard RoomHospitality Management & Culinary Arts Center | Jake Alexander BlvdHarriett Tubman Building | ClassroomJ.C. Price Building | ClassroomPoet's & Dreamer's GardenTubman Little TheaterVarick Auditorium | Main AuditoriumVarick Auditorium | ClassroomWiley Lash RoomActivity/Event to be held* Description/Purpose of Proposed Event*Please be as detailed as possible.Event Date* MM slash DD slash YYYY Anticipated Attendance*Start Time* : Hours Minutes AM PM AM/PM End Time* : Hours Minutes AM PM AM/PM Equipment & SetupEquipment RequestPlease select all that apply Chair(s) Internet Access Lights Microphone(s) Podium Projection Technology Speaker(s) Table(s) None of the Above Number of Chairs*Number of Tables*Consultation Required*The item(s) you have selected require a consultation. Please select "YES" if you would like to be contacted to have a consultation. Please note, selecting "NO" indicates that your event either does not require the selected items or you plan on providing your own. Yes No CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
