State Form 45292- Request For Room Reservation

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Department of Administration
REQUEST FOR ROOM RESERVATION
Conference Center
State Form 45292 (R11 / 6-06)
Telephone (317) 233-3117
Fax (317) 233-0011
Room reservations are filled on a first-come, first-served basis. This form is only a
conference@idoa.in.gov
request and does not guarantee a room until it is processed and confirmed by the
Conference Center.
We are not staffed as a full-service conference facility. Your careful attention to detail in the planning stages is very important. We also do not
have the full range of equipment that can be found in a full-service facility. Please be mindful of this and request only the equipment that you
really need. We will do our best to handle your request, but there may be times when you will have to go to a vendor to rent equipment.
Name of Agency Sponsoring Event
Division
Section
Contact Person
Telephone Number
Fax Number
Address (Building & Room Number)
E-mail
Name of Event
Date of Event (please include alternate dates)
Please Include Alternate Dates
Event Start Time
AM
PM
Need access before start?
AM
PM
Event End Time
AM
PM
Need access after end?
AM
PM
If you plan to serve food or have displays, this must be handled at the time of the reservation.
Food Service Planned
Displays Planned
Using The Café Group
Using Other Licensed Caterer (please specify)
Event takes place prior to 7 am or ends after 5:30 during a working day. Building Access Policy Applies, see website for details.
Event takes place over a weekend or holiday. Building Access Policy Applies, see website for details.
State employees who do not normally park in the garages will be attending. IT IS YOUR RESPONSIBILITY TO GET A LIST OF THOSE
EMPLOYEES TO THE PARKING GARAGES TO FACILITATE THEIR PARKING AND TO EASE TRAFFIC CONGESTION.
Set Up Requested
Equipment Requested
Total Number of People Attending:___
___
Podium w/ Microphone
Overhead Projector
Conference (closed or hollow square)
Podium w/out Microphone
Slide Projector
Horseshoe
Microphone (to amplify) #
Laser Pointer
Horseshoe #
+ Audience #
Microphone (to record) #
LAN Connection
Horseshoe #
+ Classroom #
Microphone (to do both) #
Easel
Theatre / Audience
Lapel Microphone #
Flipchart
Classroom (seated at tables)
Cassette Recorder
Whiteboard
Hearing Style (include diagram)
Cassette/CD Player/Recorder
Screen
Head table #
__
VCR/Monitor
Telephone
Food Service Table #
__
VCR/Monitor (Close Captioned)
Speaker Phone
Registration Table #
__
ELMO Visual Presenter
Conference Phone
Display Table #
(limitations apply)
Mixer
Mult Box
Special arrangement (include description)
Other: _
_
Special Request/Special Arrangement/Room Diagram:
__
AUDITORIUM REQUEST ONLY: Total Number of People Attending:
__
Podium w/out Microphone
Lapel Microphone #
__
CD
Podium w/ Microphone
PowerPoint Presentation (use our system, bring disk/laptop)
Cassette
Head Table for #
Internet Presentation (use our system)
VCR
Microphone for Head Table #
__
Visual Presentation (ELMO/overhead)
Laser Pointer
Floor Microphone #
___
Assistive Hearing Devices will be needed #
__
Mult Box
Tables in Atrium for Food #
__
Tables in Atrium for Registration #
__
Cassette Recorder
*PowerPoint: We have PowerPoint 2000. This software will read PowerPoint 97, 98 and 2000. Please use the “Pack and Go” function found
in “File” of your PowerPoint program and download the presentation to floppy disks or CD or you may also connect your laptop directly into the
system. For a better presentation of this particular room, do not use a dark background on your slides.
Please be advised that this is a request form only. Presentations requiring presence of staff to change modes may require that
the requesting agency hire professional audio-visual staff for the event.
CONFERENCE CENTER OFFICE USES ONLY
Date Received
Problems, if any, were addressed by:
This event involves multiple rooms or multiple
Confirmation
days. Pre-Conference Review sheets sent.
Sent
Date Received
Room(s)
Staff
This event involves multiple rooms or multiple
Contact
days. Pre-Conference Review sheets sent
sent

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