Ft. Wayne Conference Service Request
Contact
Company Name
First Name
Last Name
Email
name@domain.com
Phone
Company Address
Street Address
City
State
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Zip
Emergency Contact
Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Phone
Meeting Information
Title of Meeting
Date of Event
Time Event Begins
Time Event Ends
Approximate Number of People
Room Size Needed
Small (4 - 6 Guest)
Regular (4 - 30)
Large (31 - 110)
Tax Exempt?
Yes
No
Equipment Rental
Smart Cart: includes: screen, desktop, laptop connections, classroom speakers, LCD Projector, DVD player and podium
Yes
No
Wireless Internet
Yes
No
Flip Chart
Yes
No
Conference Phone
Yes
No
Sound System/Microphone
Yes
No
Beverage Services
Coffee
Yes
No
Individual Water Bottles
Yes
No
How many?
Individual Soda Cans
Yes
No
How many?
Case of Soda Cans
Yes
No
How many?
Unsweetened Iced or Hot Tea
Yes
No
How many?
Special Requests
How Did You Hear About Us?
Contact Information