Video Conferencing Reservation Form

Video Conferencing Reservation Form

A Video Conferencing Technical Specifications Form is also required. Some services require fees. Payment must be made in advance. Please refer to Pricing Table below.

Date
Contact Name
Department
Location
Phone
Email Address
FAX Number
Recipient Site Info:
Video Site Technical Contact
Phone
Email Address

Session Information:
Title
Date(s) of Use (MM/DD/YY)	From	through
Time of Use	From	until

Number of MSM Participants
Number of non-MSM Participants

*Preferred Location:**
Board Room (ISDN/Internet)	DITS Electronic Classroom (Internet only)
*If you want your session to take place in the Board Room, you are responsible for reserving the room. Please call Priscilla Hubbard at 404-752-1745 for more information.

Will you be requiring any specialized software or services?

Yes No

Software/services needed (please list):

Other presentation devices needed (select all that apply):

	Pointer
	Elmo Visual Presenter
	Slide Projector
	Overhead Projector
	Smart Board
	Flip Chart
	VCR

Pricing Table:

Payment for all services must be made in advance. Requisitions and checks should be made out to DITS - Instructional Technology as vendor. The following rates apply for each Lab. Please check all services that apply below:

	*E-Classroom Reservation Fees - Check all that apply:*
	MSM Academic Event	no charge
	MSM non-Academic Event	no charge
	MSM non-Academic Outside	$100.00 per hour
	Non-MSM event	$200.00 per hour
	*Video Conferencing Fees:*
	Video Conferencing - ISDN	$27.00 per hour
	Video Conferencing - LAN-based	$27.00 per hour
	Other Fees:
	Specialized software loaded	$50.00 per hour
	Onsite Technician	$50.00 per hour
	Printing	$0.10 per page

Additional comments and information:

Please refer to DITS Electronic Classroom Policies and Procedures for additional information. Where fees apply, payment is required prior to service. A DITS staff member will contact you on receipt of this form.
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