Contact Details

First Name:
Last Name:
E-mail:
Confirm E-mail:
Phone:

Non-OISE Events CC/FC numbers:


Are you submitting this form for someone else? Yes

Alternate Contact Details

First Name:
Last Name:
E-mail:
Confirm E-mail:
Phone:

Event Details

Event Name:
Event Date: (YYYY-MM-DD)

Event Start:
Event End:

Recurring every: days weeks months Until:
Other Dates:

Anticipated Event Size:
(This will help determine the system & room required.)

1-7 1-20 1-30+ 50+

Anticipated Data Sharing as part of this event?
(e.g. PowerPoint or other computer material)

Yes No

Remote Contact Info

* Additional remote sites, exceeding the maximum number provided below, can be added by employing a 3rd party service provider at additional costs

Site 1

Site Name:
Contact:
Contact E-mail:
Confirm Contact E-mail:
Contact Phone:
Remote System Type:
Remote IP Address:

Site 2

Site Name:
Contact:
Contact E-mail:
Confirm Contact E-mail:
Contact Phone:
Remote System Type:
Remote IP Address:

Site 3

Site Name:
Contact:
Contact E-mail:
Confirm Contact E-mail:
Contact Phone:
Remote System Type:
Remote IP Address:

Additional Info/Comments: