Please use this form to request satellite-delivered Teleconferences or off-satellite recordings.

Our primary room for viewing live Teleconferences is LR 033 - room 33 of of the Richard Hagemeyer Learning Resources Center on the CPCC Central Campus.  Seating capacity for LR 033 is 32 persons classroom-style.  Please contact Jim Bailey at 704.330.6994 if you need alternative seating arrangements. 

Please allow 3 weeks lead time for your conference.

PROGRAM INFORMATION

Title

Program originator

MON TUE WED THU FRI SAT SUN Day
Date
JAN FEB MAR APR MAY JUNE JUL AUG AUG SEP OCT NOV DEC Month
2005 2006 2007 Year

Start time
End time

  choose one Yes No Is a license fee required for accessing the signal?

choose one Yes No Has it been paid?
Please provide the following information if a "technical contact" is requested as part of the registration process with the originator:
Jim Bailey
704.330.6994
jim.bailey@cpcc.edu

Satellite Technical Information

choose one Yes No Is program information available on a specific web page?

If so, please provide the URL.

ATTENDEE INFORMATION

choose one Yes No Attendees expected?

1-5 6-10 11-15 16-20 21-25 26-32 If "yes", how many do you expect?
choose one Yes No Will they be pre-registered?
choose one Yes No Is there a registration fee for attendance?
If so, what is the registration fee?

choose one Yes No Are you providing a facilitator for the CPCC site?

choose one Yes No Are you planning to provide refreshments for attendees?
If "yes" please call CPCC TV at 704.330.6994.

choose one Yes No Interpreter for the Deaf/Hard of Hearing needed?

FORM COMPLETED BY:

Your name (first last)

phone

email

BILL TO:
If this Teleconference is not being requested by an instructional, support, or administrative unit of CPCC, a nominal fee will apply.  Call CPCC TV at 704.330.6994 for more information.

To the attention of: (person's first & last name)

Organization

Street address or P.O. Box

City

State

Zip

phone

email

Thank you for your request.  You will be contacted shortly concerning any additional details we may need to make this Teleconference a valuable experience for all attendees.