Facilities Use Request - Internal Clients

Today's Date:

Event Details

Event Date

~ JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 1212 Month

~ 12345678910111213141516171819202122232425262728293031 3131 Day

~ 202420252026202720282029 Year

Duration of Event:

Single day.

Repeating (e.g., one Monday every month).

Multi-day (e.g., three days long). Please provide additional dates: •

Additional Details:

Event Name:

How many attendees?

Facility Access Time:

~ 123456789101112 Hour

~ 00153045 Minutes

~ ampm am/pm

Event Start Time:

~ 123456789101112 Hour

~ 00153045 Minutes

~ ampm am/pm

Event End Time:

~ 123456789101112 Hour

~ 00153045 Minutes

~ ampm am/pm

Facility Exit Time:

~ 123456789101112 Hour

~ 00153045 Minutes

~ ampm am/pm

Room Organization

Room Setup:

Tables in U-Shape

Standard classroom configuration

Other (Please Specify)

Please indicate how many of the following items your event will require.

Easels 0 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950

Podium 0 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950

Registration Tables 0 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950

Chairs for registration tables 0 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950

Other items? (Please Specify)

A/V Services

Do you require and Audio Visual (A/V) Services?

Yes

No

If "YES":

1. Please complete an A/V request using the Audio/Visual Request System app found in the MCC4me portal > My Mott Applications.
2. Contact ITS Media Services at (810) 762-0364 if you have any questions.

Contact Information

MCC Department:

Contact Person:

Best way to contact:

Work Telephone Provide Work Number

Cell
Provide Cell Number

Email
Provide Email Address:

Attending Representative

Representative Name:

In case of an emergency, please enter a cell number so we can contact the representative while they are in the facility?(e.g., (xxx) xxx-xxxx) •

Attending representative's email:

IP