Burnaby

Name

Title

Email

Telephone

Postal Code / Zip

Organization/Department

Address

City

Province / State

Country

Account Number to be Billed Format: (Fund-Dept-Program OR Fund-Project ) For Externals, please put N/A

Start Date

Do you require multiple dates? If you are requesting multiple dates, please list dates and times here. Include any other event details.

Number of Attendees

Audio Visual Equipment Data Projector & Computer Microphone Podium Microphone

Other - Please describe below:

End Date

Meeting Space

Number of Breakout Rooms

Do you require catering? Yes No

Is admission to the Event restricted to University Community Members or to another group, or is admission to the Event unrestricted? Restricted Unrestricted

Will alcohol be served? Yes No

Are admission tickets being sold? Yes No

Do you require overnight guest rooms? Yes No

Are news media being invited or might the Event attract media? Yes No

Are any high-level dignitaries, elected officials, or VIPs participating or invited to attend? Yes No

Is the planned Event being publicly advertised through social media, websites, or other channels? If so how, where, and when

Has the Event Organizer, the organization, their representatives, or any potential speakers attracted adverse publicity and/or protest in the past? Please describe.

Has the planned Event’s purpose or theme attracted adverse publicity and/or protest in the past? Please describe

Is any external security being contemplated, requested, or retained by the Event Organizer? Yes No

How did you hear about us? Attended event Advertisement Repeat client Trade show Web search Other Referral

I acknowledge that my submission is complete and contains all information that I have at my disposal at this current time. As new details arise or plans change I will inform Event and Space Reservations as it may void the existing approval Yes

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