Video Conferencing Form

Video Conferencing Form

Please Select Your Preferred Method of Confirmation:

Scheduler's Information

Full Name: *

Your Position

E-Mail

Phone #:

Fax #:

Scheduling and Billing Information

Company Name:

Street Address:

Address Continued

City:

State

Zip:

Phone #:

Phone Extension:

Billing Contact:

Billing Street Address:

Billing Street Cont:

Billing City:

Billing State:

Billing Zip:

Billing Phone #:

Conferencing Details

Video Conferencing Facilities Needed

Number of Facilities Needed:

Locations Needed by City, State

Seating Capacity At Each Location:

Conference Date:

Pre-Test Time:

Time Zone:

Conference Start Time:

Conference End Time:

Conference Coordinator Name:

Conference Coordinator Phone #:

Extension:

Type of Conference: Point to PointMultipoint

If Multi-Point, Number of Sites

Transmission Rate

Conference Room Profiles

Site 1

Provided By

State/City:

Site State:

ISDN Full Number:

Originates Call

Technical Contact:

Technical Phone #:

Site 2

Provided By

State/City:

Site State:

ISDN Full Number:

Originates Call

Technical Contact:

Technical Phone #:

Site 3

Provided By

State/City:

Site State:

ISDN Full Number:

Originates Call

Technical Contact:

Technical Phone #:

Site 4

Provided By

State/City:

Site State:

ISDN Full Number:

Originates Call

Technical Contact:

Technical Phone #:

Site 5

Provided By

State/City:

Site State:

ISDN Full Number:

Originates Call

Technical Contact:

Technical Phone #:

Site 6

Provided By

State/City:

Site State:

ISDN Full Number:

Originates Call

Technical Contact:

Technical Phone #:

Additional Information:

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