NYU Wagner

Video Conferencing Request Form

Requests for a video conference space at NYU require a faculty attendee and advance notice of at least four business days.

Detailed information on video conferencing is available at http://www.nyu.edu/its/conferencing/.

1. Contact information

First Name:

Last Name:

Email Address:

Phone Number:

2. Contact information for facility/institution participating in video conference

Name of Facility/Institution:

Contact person at facility/institution:

Email:

Phone#:

3. Choices Date/Time

Date(s) requesting videoconference: First Choice: Month... January February March April May June July August September October November December Day... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year... 2006 2007 2008 2009 2010

My event/meeting starts at: Hour... 1 2 3 4 5 6 7 8 9 10 11 12 Minute... :00 :15 :30 :45 AM PM

My event/meeting ends at: Hour... 1 2 3 4 5 6 7 8 9 10 11 12 Minute... :00 :15 :30 :45 AM PM

Second Choice: Month.. January February March April May June July August September October November December Day.. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year.. 2006 2007 2008 2009 2010

My event/meeting starts at: Hour.. 1 2 3 4 5 6 7 8 9 10 11 12 Minute.. :00 :15 :30 :45 AM PM

My event/meeting ends at: Hour.. 1 2 3 4 5 6 7 8 9 10 11 12 Minute.. :00 :15 :30 :45 AM PM

4. Participants at NYU site

Less than 10 Between 10 and 25

*Our room can hold about 10-12 people seated around the tables and about 25 without the tables

5. Recording/Presentation

Would you like the conference to be recorded?

Yes No

Will you be using a Powerpoint presentation?

Yes No

6. Faculty Sponsor

7. Questions/Comments