Close [X] 

Video Conference Request Form
* All fields are required

View Presentation Guidelines

Contact Information:
Name:*
Email:* Phone Number:*
Rensselaer Contact*
Department or School:*
Check if Contact is different than Requestor:                                           

List the event for which this unit will be used
Event Location*
Event Title*
Event Date*  
Event Start Time* Event End Time*
Event Duration*

Number of Participants*
Requirements
     Laptop Integration
     Document Camera
     DVD/VHS Playback
     Telephone Conferencing into VC

Additional Event Instructions
Technical Conference Information:
Technical Contact Name:*
Business/Department:*
Contact Number:*        Email:*
IP Address:
ISDN Dial-in Numbers:
ISDN Dial-in Numbers:

Financial Information:

Any event(s) where there may be multi-site partipation may require a Video Conference bridge. Bridge charges will be incurred by all participants and billed directly to you by the bridge service provider. Reservations cannot be booked without this information.

Are you paying through an RPI account?*

Yes No                                



      

return to MMS homepage