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Middle Georgia RESA Professional Learning Request Form
(Registration AND Room Request)
Room requested by *
Your answer
Date requested: *
MM
/
DD
/
YYYY
Contact for the person responsible for the event
Name: *
Your answer
Email: *
Your answer
Telephone: *
Your answer
Title of the Event: *
Your answer
Room Request
First Choice Desired location: *
Your answer
Second Choice Desired Location *
Your answer
Type of room needed: *
Room set up specifics: *
Event/Meeting date(s): *
Please be specific.
Your answer
Max # of Participants *
Your answer
IT and/or AV needs (projector & screen, computer, internet access, microphone, interactive whiteboard, etc.)
Your answer
Start time for room usage: *
Time
:
End time for room usage: *
Time
:
Food Services needed:
Do you need registration? *
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