Lecture Information

1. Name of Organization or Event
2. What status type is your group?

   Non-Profit For-Profit University of Utah Department
3. Contact Name
4. Contact Phone
   (xxx-xxx-xxxx)
5. Contact Email
6. Billing Name
7. Billing Phone
   (xxx-xxx-xxxx)
8. Billing Address
9. City
10. State/Province Select State/Province: Utah Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming ----------------- Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Islands Quebec Saskatchewan Yukon Territories ----------------- --- Not Applicable ---
11. Zip/Postal Code
12. Lecture Date(s)
13.  
14. Rooms being used for your event:
    Select all that apply.

    Libby Gardner Concert Hall Green Room 252 Thompson Chamber Music Hall Dumke Recital Hall Green Room 402 Classroom 410
Registration/Check in
15. Registration Start Time
16. Registration End Time
17. Will you need a registration table?

    Yes No
How many 6' registration tables?
How many 8' registration tables?
18. Where do you want check in to be located?
19. How many chairs are needed at the buffet table?

First Lecture Day

1. Date
2. Set Up Time
3. Sound Check
4. Start Time of Lecture
5. End Time of Lecture
6. Breakout Rooms needed?

   Yes No
Number of rooms needed?
Rooms need to hold
Session 1 Start Time
Session 1 End Time
 Add another Breakout Room
Session 2 Start Time
Session 2 End Time
 Add another break out session
Session 3 Start Time
Session 3 End Time
Do you need AV equipment in the break-out rooms?
Yes No
7. Will there be a meal break?

   Yes No
Will the meal be catered?
Yes No
Name of Caterer
Caterer Phone
(xxx-xxx-xxxx)
Caterer Email
Arrival Time of Caterer
Number of parking spots needed by caterer
(Limit 2)
Start of Meal
End of Meal
8. Will there by a Q and A session as part of the lecture?

   Yes No
Do you want cordless microphones on stands at the end of both aisles close to the stage?
Yes No

---

Second Lecture Day

9. Date
10. Set Up Time
11. Sound Check
12. Start Time
13. End Time
14. Will break-out rooms be needed?

    Yes No
Number of rooms needed?
Rooms need to hold
Session 1 Start Time
Session 1 End Time
 Add another Breakout Room
Session 2 Start Time
Session 2 End Time
 Add another break out session
Session 3 Start Time
Session 3 End Time
Do you need AV equipment in the break-out rooms?
Yes No
15. Will there be a meal break?

    Yes No
Will the meal be catered?
Yes No
Name of Caterer
Caterer Phone
(xxx-xxx-xxxx)
Caterer Email
Arrival Time of Caterer
Number of parking spots needed by caterer
(Limit 2)
Start of Meal
End of Meal
16. Will there by a Q and A session as part of the lecture?

    Yes No
Do you want cordless microphones on stands at the end of both aisles close to the stage?
Yes No

1. Speaker's Podium with microphone?
   ($150)

   Yes No
Describe placement of podium on stage.
2. Cordless microphone on stand?
   ($50 ea.)

   Yes No
# of microphones
3. Will you need chairs placed on stage for lecturers?

   Yes No
How many?
Where do you want the chairs placed in relation to the speaker's podium?
4. Will there be any change in stage needs for the second day?

   Yes No

Libby Gardner Concert Hall does not have AV equipment. The School of Music can rent AV equipment through the University of Utah Teaching and Learning Technologies (TLT), and have it delivered and set up.

Screens

1. What size of screen do you need?
   Select all that apply.

   Standard 52" X 70" - TLT 70" X 70" Screen - School of Music Large 10' X 10' Screen - TLT
2. # of screens needed

Projectors

3. Please let us know what you are wanting to project and the size of audience you are anticipating.
4. Please let us know if your event has any other needs.