Form to Schedule an Event

Required fields are marked with an asterisk. *

Personal Information

First Name*  
Last Name*  
Organization  
E-mail Address*  
Phone Number*  
Cell/Alternate  
Address  
City  
State  
Zip  
Relation to Southwestern  Unrelated to Southwestern
 SC Related (student, faculty, or staff)

Event Details

Event Name*  
Event Date*  
Start Time*  
End Time*  
Approximate attendance*  
This request is for Room Only
Catering Only
Room and Catering
Equipment needs
(check all that apply)
 None
 Flip Chart/Paper
 Laptop Computer
 Overhead projector
 Microphone
 Podium
 Projection Screen
 TV/VCR

Additional Information

How did you hear about us?

 

Additional requests