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ACE Facilities Registration Request Form

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Course/Event Information

Subject or Course Title
 Instructor/presenter name(s) (if applicable)
Description of Event/Course
 Instructor/presenter contact information during course/event (if applicable)
  Instructor/presenter provided equipment (if applicable)
PC Laptop, MAC Laptop, overhead projector, etc.

Daily Start Time
 Daily End Time
 If the times of the course vary, please list the times in the Special Instructions field.

Primary Requested Dates (mm/dd/yyyy)
Start Date:   End Date: 		Alternate Requested Dates (mm/dd/yyyy)
Start Date:   End Date:

Event Type

Anticipated Number of Attendees

Equipment/Room Requirements

Wireless Internet Connectivity Available Throughout Facility

Participants to use their own laptopsN/A

Please Indicate Equipment Required  
Projector/Screen  
Podium  
Flip Charts How Many? 
Breakout Rooms How Many? 
Video Recording Event  
Presenter Table  
Mobile Marker Boards  

Choose Room Layout  
Classroom Style
 Pod Style

POC / Alternate POC Information

POC Name
 POC Email Address
 POC Phone Number
Alternate POC Name
 Alternate POC Email
 Alternate POC Phone Number
Instructor Type (required)
   Instructor Arrival Time

Special Instructions

Please type in the characters you see below in the field provided:

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