Video Conference Request Form
VB - Off Site

If your VTC is being held in a CLASSROOM or SPECIAL EVENT ROOM you must:

Reserve the room with the Registrar (classroom) or Facility Services (special event room). Inform the Registrar that you will be using VTC in that room. (Call 757.352.4049.) Submit this Media Services VTC Request Form after completing steps one and two above.
Contact Information
Regent University Contact Information
Your Information
Name:
Phone Number:
Email Address:

Have You Scheduled Your VTC Through the Registrar's Office?	(Type "yes" or "no")
Please Select Your Affiliation:
Are You a First-Time User?:
Do You Need Training?:
Offsite Contact Information

Name of First Off-Campus Location:
Technician Information
Name:
Phone Number:
Email Address:

Name of Second Off-Campus Location: (if applicable)
Technician Information
Name:
Phone Number:
Email Address:

Event Information

Name of the Event:
Instructor or Speaker Name:
Campus Room Reserved:
Timing
Day of Week:
Date of Event(mm/dd/yyyy):
Start Time:
End Time:

Additional Information
Special Instructions or Additional Details:
Please Note:

If you need any additional equipment, please indicate in the "Special Instructions" box above. If you are unsure about what specific equipment you may need, please describe your presentation needs below.
If there are multiple dates, please enter the first date in the "Date of event" box and list the other dates in the "Special Instructions" box above.