Facility Use Request / Event Registration Form
Complete this form. It will automatically notify COP Support Staff of your request.
NOTE: Completing this form does not guarantee a space is reserved. The cost to reserve a room varies by location. You will receive a confirmation email once a room has been reserved, and any room use fees will be shared with you at that time.
Email address *
Our Why: To engage learners in ways that foster growth and success.
Title of Workshop / Event *
Your answer
Date of Session *
MM
/
DD
/
YYYY
If multiple days/dates - list them here
Your answer
Start Time of session
Time
:
End Time of session *
Time
:
Contact Person/Cell Phone/Email address *
Your answer
Presenter Name/Cell Phone/Email address *
Your answer
Handouts/Materials will be provided by Presenter *
Number of Participants *
Your answer
Target Audience *
Your answer
COP ESD is unable to host events for more than 10 attendees at our Indian River office. Please indicate your preferred event site location. NOTE: We will do our best to accommodate your request, subject to availability. *
Required
Cost for Participants
Your answer
Registration on Wisdomwhere *
Please choose preferred registration option:
Session Description - Please be specific as this will be the narrative on the registration site (Wisdomwhere). *
Your answer
Food / Beverage Request *
Coffee/pop/water ONLY ($2 per person)
Lunch - includes beverages. ($10 per person)
No Food or beverages
Check all that apply
Indicate dietary restrictions here:
Your answer
Preferred Room Set Up Choices (Options vary by location) *
4/pod
6/pod
Classroom
Hollow square/rectangle
Solid Rectangle
Horseshoe
Chairs ONLY
Select One
Equipment Requested - select all that apply *
Required
Applying for SCECHs? *
Submit
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