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 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 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 CAPTCHANameThis field is for validation purposes and should be left unchanged.
