New Game Room Event Request Form
New Game Room Event Request Form
Name of Organization or Department
*
Name of Program or Event
Form of Payment
*
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Credit Card pay at event
Chartstring (please list full number)
*
Name
Name
*
First
Last
Email
*
Phone
Phone
*
-
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-
###
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Estimated Number of Participants
*
First Preference Date
First Preference Date
*
/
MM
/
DD
YYYY
First Preference Time
First Preference Time
*
:
HH
MM
AM
PM
AM/PM
Second Preference Date
Second Preference Date
*
/
MM
/
DD
YYYY
Second Preference Time
Second Preference Time
*
:
HH
MM
AM
PM
AM/PM
Third Preference Date
Third Preference Date
*
/
MM
/
DD
YYYY
Third Preference Time
Third Preference Time
*
:
HH
MM
AM
PM
AM/PM
Will you need catering?
*
Yes
No
What space are you looking to reserve?
*
Nexus Gaming Lounge
The Game Room
Both