Saginet IP 204.38.47.135
ISDN number 700-380-1350

Completed form must be submitted within 3 business days of the event.



Items denoted with a red asterisk * are required.
Event Name
 
Event Date
 
Click to View Date Picker
Event Start Time (Eastern Time)
 
(hh:mm am/pm)
Event End Time (Eastern Time)
 
(hh:mm am/pm)
Site Name/Location
 
Cart
 
 * IP Address/ISDN Number
 
Connection Speed (i.e. 384k)
 
Event Coordinator Name
 
Event Coordinator E-mail Address
 
Event Coordinator Phone Number
 
 -  - 
(XXX)-XXX-XXXX
Number of Participants
 
Tech Name
 
Tech e-mail address
 
Tech Phone Number
 
 -  - 
(XXX)-XXX-XXXX
 * Phone number in case there is a problem during the event
 
 -  - 
(XXX)-XXX-XXXX