* Requested Information

First Name*:

Last Name*:

Phone Number*:

Regent Email*:

Class Name: (if applicable)

Class Number: (if applicable)

Project or Event Name*:

Instructor or Executive Producer*:

Room requested:

If you choose "Other Room" from the pull-down menu above- please type in the name of the "Other Room" desired:

2nd Choice - if your above room is not available:

Will non-Regent University personnel be invited to this activity?*

Yes   No

If so, in what capacity?:

One time reservations:

Date requested:

Beginning time:

Ending time:

Please explain fully the activity that will take place in this room:

Are any additional Support Rooms required for this project?

No   Yes

If Yes, please list any and all Support Rooms that are needed, and explain fully the purpose for which these rooms are requested:

Recurring Reservations:

Please explain in detail (including all dates and 'start & stop' times - from 'move-in' to 'move-out') any room request that must recur in the future:

This form is to be used for COM School-related reservations ONLY.

Non-COM School requests should be directed to Rick Hall @ 352-4744.

Non-COM School usage of the facilities and staffing of the Performing Arts Center may incur charges to the group, school or department making the reservation.