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Name: (Title, Last, First, Middle and Suffix)

Department, or program:
UALR E-mail address:
Phone number (include area code):
Class or event title:
Number of participants (max 28):
Please give us a brief description of your class or event:

Would you like to reserve the North Lab or the South Lab (if you're not sure, you can read about both sections on the Facilities page):
North Lab 2 rows of 8 seats 1 row of 7 seats — total of 23 seats
South Lab 6 tables of 4 or 5 seats — total of 28 seats
Both
Please select the dates and times you will be needing the lab:
Start Date: Start Time:
End Date: End Time:
Will you need any Audiovisual Equipment?
Projector ELMO VCR SmartBoard Laptop Connection	DVD Player Large Screen TV Easels Easel Paper Training in the use of any of the above.

Please provide any additional information about your class or event: