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Room Reservation Request Form

* Name:
* Department/Office:
* Contact Phone
[where we can reach you most easily]
E-mail:
Room/Space Requested:
* Date(s) Needed:
* No. of Participants:
* Start Time:
[indicate a.m. or p.m.]
* End Time:
[indicate a.m. or p.m.]
Purpose for Use:
Special Room Needs:
[e.g. Internet access, kitchen,etc.]
Questions/Comments: