Meeting Request Form




(indicates required information )

	Meeting Name:

Organization & Contact Information
	Organization/Company:
	Department/Sponsor:
	First Name:
	Last Name:
	Title:
	Street Address:
	WUSM Box/BJC Mailstop#:
	City:
	State:
	Zip Code:
	Country:
	Telephone:
	Alternate Telephone:
	Fax:
	Email:

Conference General Information
	Expected Number of Attendees:
	Meeting Description:
	Preferred Dates:
	Alternate Dates:
	Meeting Time:
	Date Comments:

Lodging Information

Number of Nights Needed:

Night	Singles	Doubles	Dbl/Dbls	Suites	Total
1
2
3
4
5
Total

Desired Guest Room Rate Range:
General Room Comments:

Event Information

Number of days for the event:

Day	Start Time	End Time	Set-up	Area(sq.ft.)	Attendees
General Session(1)

Lunch

Break Out Sessions

Event Budget:
General Event Comments:

	Special Instructions
	Facility Response Due By:
	Group Decision Date:
	Response Method: