Room Request

Name of Program or Meeting:

Organization Requesting Space:

Address:

City: , State: Zip:

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Reservation/Billing Contact Person:
Name:

Prefix:
First Name:
Nick Name:
Middle Name:
Last Name:
Suffix:

Email:
Telephone:
Fax:

Will you be using a caterer for this event?

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In case of inclement weather, early morning or late night contact:
Name:

Prefix:
First Name:
Nick Name:
Middle Name:
Last Name:
Suffix:

Home Telephone:		Time Range:
Cellphone:		Time Range:

Who will be the on-site event contact?
Name:

Prefix:
First Name:
Nick Name:
Middle Name:
Last Name:
Suffix:

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Check all that apply:
Monday Tuesday Wednesday Thursday Friday Saturday

Please record actual start and end times.
(An additional 30 minutes is assumed for set-up and tear-down.)

Start Date of Event:
Final Date of Event:
Start Time:
End Time:
Arrival Time:

Are dates and/or times negotiable?

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The largest classroom at HMHEC can hold up to 65 people. We have up to 12 rooms available for events requiring more than a single room.

What is the anticipated number of participants?
Cost to participants:

Check options requested:

Smart Classroom (?) - includes mounted data projector, computer, DVD/VCR connected to data projector, hook-up for laptop, Internet access, wall-mounted speakers, wall-mounted white board, document/overhead projector, interactive touch screen, Smart sympodium, and on-site technical support.

Additional set-up and equipment needs (surcharge may apply):
Computers for participants ($50 per cart of 24 laptops)
Flip charts and markers ($25 total) - Flip charts
Conference speaker-phone ($25)
Wireless pointer ($10)
Handicap-accessible desk(s) ($0)
Wireless microphone

Wireless lapel ($25)
Wireless handheld with stand ($25)

Other

Please specify:

Videoconferencing Room (?) - includes amenities of Smart Classroom, as well as two-way interactive videoconferencing, and turnkey technical support.

If you know the following information, please provide it here:
Originating Site:
Connection Type:
Video Conference Technical Contact:
Name:

Prefix:
First Name:
Nick Name:
Middle Name:
Last Name:
Suffix:

Email:
Telephone:

Additional set-up and equipment needs (surcharge may apply):
Computers for participants ($50 per cart of 24 laptops)
Flip charts and markers ($25 total) - Flip charts
Conference speaker-phone ($25)
Wireless pointer ($10)
Handicap-accessible desk(s) ($0)
Other

Please specify:

Computer Lab (?) - includes amenities of Smart Classroom, as well as 25 Nova computer stations and on-site technical support.

Additional set-up and equipment needs (surcharge may apply):
Flip charts and markers ($25 total) - Flip charts
Conference speaker-phone ($25)
Wireless pointer ($10)
Handicap-accessible desk(s) ($0)
Wireless microphone

Wireless lapel ($25)
Wireless handheld with stand ($25)

Other

Please specify:

Board Room (?) - includes telephone; no other standard equipment.

Additional set-up and equipment needs (surcharge may apply):
Laptop computer ($25)
Internet access for customer equipment ($25)
Mobile data projector ($25)
Television with DVD/VCR ($25)
Flip charts and markers ($25 total) - Flip charts
Wireless pointer ($10)
Handicap-accessible desk(s) ($0)
Wireless microphone

Wireless lapel ($25)
Wireless handheld with stand ($25)

Other

Please specify:

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Briefly describe the agenda and the target audience. If the request is for a training or educational program, please include the program’s goals, the instructor’s credentials, the program’s anticipated outcomes, and the program’s estimated budget.

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How did you hear about HMHEC?

Yes, I have read and agree to follow HMHEC's room usage guidelines. Please review them now if you have not already done so.

You must check "Yes" above for your request to be submitted.

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Room Request