Summer Conference Interest Form

Name of Event *
Name of Group *
Billing Address *
Street address Address line 2 City State/Province/Region Postal/Zip code Country
Contact Person First Last
Contact Phone Number - Area Code - Prefix Line Number
Contact Email
Emergency Contact Person First Last
Emergency Contact Number - Area Code - Prefix Line Number
Estimated Date of Conference / MM / DD YYYY
Estimated End Date of Conference / MM / DD YYYY
Please agree to the following I understand that providing an estimated start and end date on this form does not guarantee this timeframe will be available. I understand that the Office of Residence Life & Housing will confirm the availability of the dates listed, and work with me to find a new date if the dates listed on this form unavailable.