Please complete the information below:

Name * Company * Address * City * State * Select an option:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDist of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Phone * Email *

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Type of Event * Description of Event

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Type of Organization Select an option:Education InstitutionNon-ProfitGovernment AgencyFor-Profit Business

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Date *

Event start time *

Event end time *

Expected number of attendees *

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Equipment needed (select all that apply)

Computer LCD projector Microphones A/V technician Audio

Meeting aids needed (select all that apply)

Conference phone Laser pointer/clicker

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Catering needs (select all that apply) *

Breakfast Lunch Dinner Snack None

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Is this your first time renting the Conference Center at Prairie State College? *

Yes No

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How did you hear about us? *

* indicates required fields