UCR Palm Desert Event Reservation Form

Bold text indicates that the field is required.

Contact Information

Full Name

Phone Number

Extension

Email Address

Organization or Business Name

Department

Event Information

Name of Event

Date (MM/DD/YYYY)

Time (HH:MM)

Estimated Duration

Estimated Number of Participants

Promotional Materials

Signs

Promotional Material

Advertising

Printed Program

Nametags

Equipments & Set-up

Please enter the quantity that you require for each of the items below.

Document Camera:

Computer:

VCR:

DVD:

Video Conferencing:

Traditional Overhead Projector:

Microphone (handheld):

Microphone (lavalier):

Assisted listening devices:

Laser pointer:

Will you need assistance with set-up? Yes No

Will you need assistance with clean-up? Yes No

Will you need assistance with A/V? Yes No

Please Choose Your Desired Room Set-up:

Food & Beverage Information

Are there Meals or Beverages planned? Yes No

Who is responsible for the food and beverages?

Please check the boxes next to the items that you require:

Breakfast:

Coffee:

Lunch:

Reception:

Bar:

Dinner:

Breaks:

Billing Information

Will this be a paid event? Yes No

Budget

Who is responsible for the budget?

FAU number to charge (UCR Customers Only)

Comments or Questions

Please leave comments or questions for the event manager here