Northeastern University John D. O'Bryant African-American Institute
Facilities Reservation Form

Please download the Reservation Form (you may use the attached PDF document, or print/copy and paste the form below) and send via fax to: (617) 373-4915, or via email as an attachment to: st.porter@neu.edu

Please do not advertise or promote your requested event until you receive a confirmation email.

Thank you!

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Today's Date: __________________________________________


Event Date:
____________________________________________


Title of Event: __________________________________________

______________________________________________________


Description of event: ____________________________________

______________________________________________________


Estimated Attendance: ___________________


Open to the Public:  Yes ___   No ___


Admission Charge:  Yes ___  No ___


Facility to be reserved (check one):

Cabral Center ___
Conference Room ___
Library ___
Classroom ___


Reservation Time:

___________________ to  ___________________


Event Time:

___________________ to  ___________________


Sponsoring Organization:
_________________________________


Dept. Head/Advisor: _____________________________________


Name of Requester (print and sign):

______________________________________________________


______________________________________________________


Day Time Phone: ________________________________________


Evening Phone: _________________________________________

Local Address: __________________________________________


SET-UP (check one)

Theater/Auditorium: ___   # Chairs ___
Circle: ___   # Chairs: ___
Banquet: ___#   (round tables seat 8-10) ___
Reception : ___
Other: ___________________


EQUIPMENT (check all that apply)

Podium: ___
Microphone: ___
Chairs: ___
Tables: ___
Platform: ___
Projector: ___

Contact/Hours

Stanley Porter
Tel: (617) 373-4919
E-Mail: st.porter@neu.edu

Hours:
Monday - Friday
8:30AM - 4:30PM