Please use this form to request videoconferences in our North Carolina Information Highway (NCIH) facility, located in LR 035 - room 35 of of the Richard Hagemeyer Learning Resources Center (classroom-style seating capacity of 32).  For directions, please see our "virtual tour". 

Please allow 3 weeks lead time for your conference.

PROGRAM INFORMATION

  select one single program series Program frequency

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

Start time
End time

Origination Site is:
CPCC
Other

"Not applicable" if CPCC is the origination site.If the origination site is "other", please provide name, contact person, and phone/email.

If CPCC is the origination site, please list the other sites you plan to include.

choose one Yes No Have the facilitators at these sites been contacted regarding room availability?

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

If so, please provide the URL.

ATTENDEE INFORMATION

1-5 6-10 11-15 16-20 21-25 26-32 How many attendees 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?

FORM COMPLETED BY:

 Your name (first last)

 phone

email

BILL TO:
If this videoconference is not being requested for an instructional, support, or administrative unit of CPCC, a nominal fee will apply. 

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 videoconference a valuable experience for all attendees.