New Media Video Conference Request Form

JTS Department Contact Information
	Request Date:
	Requesting Department:
	Budget Code:
	Name of Requester:
	Requester's Email:
	Requester's Phone:
	Requested on Behalf of:

Event Information
	Event Date:
	Event Name:
	Room Confirmation #:
	Please fill out a Room Request Form with Facilities if requesting a specific space.
	Number of Attendees:
	Number of Locations:
	Event Start Time:	(Eastern Time)
	Event End Time:	(Eastern Time)
	Video Test Date:
	Video Test Time:

	Please provide contact information and IP addresses for all conference locations:
	Name, email, telephone, and IP address are required for each location

	Please provide any special details regarding this request for video conferencing:

The Jewish Theological Seminary