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Room Request Form

To reserve a meeting room at the Memorial Fund, first complete and submit the following Room Request Form. You will then receive an e-mail from the Event Coordinator to confirm space availability and guide you through the Room Request Procedure.

PLEASE NOTE: Your arrangements are NOT confirmed until you provide the documents/information listed on the Room Request Form AND receive a Confirmation Notice from the Event Coordinator. We also recommend that you familiarize yourself with the Room Specifications before submitting this form.

Meeting Information

Date of meeting (mm/dd/yy)*	Time begin*	Time end*
Purpose of meeting*	Number of participants*	Number of children*
Signs will be posted within the building to direct your meeting participants to the correct entrance for the conference suite. What wording would you like on the signs?*
Name of Facilitator (if applicable)	Facilitator’s Phone	Facilitator’s Email

Arrangements for space and supervision for children need to be cleared with the Memorial Fund’s Event Coordinator before the event.

Room and Equipment Information

Room Requested:* Board Room Community Room

Room Set-up (for Community Room only):*

rounds of 6 (48 max.)	rounds of 8 (64 max.)	U-shaped (25 max.)
square (35 max.)	theater (75 max.)	classroom (40 max.)

Audio/Visual Equipment Requested:*

Equipment Notes

WCGMF will provide each meeting with water and coffee/decaf coffee/tea. Additional Requests:

Sponsoring Organization (Agency)

Are you a current Memorial Fund Grantee? * yes no
Are you a state or local agency?* yes no

Organization Name*

Organization Address (City, State, ZIP)*

Meeting Sponsor Name*

Phone*	Fax*	Email*
Administrative Contact Name (if different)
Phone	Fax	Email

Questions? Please contact the Event Coordinator.

none	TV/VCR	flip chart & markers	LCD projector	laptop
easel	DVD player	overhead projector	conference phone