HITS Videoconference Request Form

Before making a reservation please read the terms and conditions for this service.
Room reservations must be received no later than three weeks prior to the event date.
This form does not confirm a reservation. Once you have completed this form, ITS will contact you within 48 hours regarding your request.
For more information please contact Academic Technologies Interactive Video scheduling at (808) 956-2724 or itvscheduler-l@lists.hawaii.edu

Requestor Information

Name:

Company/Organization:

Phone Number:

FAX Number:

EMAIL:

Address:

Donotuse:

Person Responsible for Event (Event Coordinator, Committee Chair, or Presenter)

Name:

Phone Number:

EMAIL:

Conference Information

Purpose of Conference:

Title of Conference:

Conference Date (MM/DD/YY):

Conference Start Time (HST):

Conference End Time (HST):

Originating Site (please choose only one)

	Estimated Attendance
University of Hawaiʻi at Mānoa:
University of Hawaiʻi at Hilo:
University of Hawaiʻi at West Oʻahu:
UH Maui College:
Kapiʻolani Community College:
Kauaʻi Community College:
Leeward Community College:
University Center at West Hawaiʻi:
Windward Community College:

Receiving Site(s)

	Estimated Attendance
University of Hawaiʻi at Mānoa:
University of Hawaiʻi at Hilo:
University of Hawaiʻi at West Oʻahu:
UH Maui College:
Hawaiʻi Community College (Pālamanui Campus):
Honolulu Community College:
Kapiʻolani Community College:
Kauaʻi Community College:
Leeward Community College:
Windward Community College:
UHMC Hana Education Center:
UHMC Lahaina Education Center:
UHMC Lanaʻi Education Center:
UHMC Molokaʻi Education Center:

Billing Information

If rates apply, send invoice to:

Name:

Company/Organization:

Department:

Phone Number:

FAX Number:

EMAIL:

Address:

Statement of Agreement

I have read and agree to the terms and conditions of this service (this is required to submit Request Form).