Exhibit A

Scheduling Request Form

Thank you for your interest in hosting your event at the Truhlsen Campus Events Center.

Please refer to our Facility Use Fee, Facility Guidelines and Facility License Agreement before completing this form.

You acknowledge that you have read and understand the contents of the above documents.

When you have completed the form, please click "Submit" to Email it to the UNMC Events Center Coordinator.

Please contact the Events Center Coordinator at (402) 559-5192 with any questions.

*Required Fields

Requestor:* E-mail:*

Phone:* Fax:

Is there a Contact Person different from Requestor:* Yes No
(Please fill out the contact information that will appear on the form if you check Yes.)

Is this a university sponsored event?

Yes, this is a university sponsored event No, this is a public event

Event Name:

Event Type:*

Please let us know how you heard about us:*

Date: * Calendar

Estimated Attendance:*

Time Event Begins:*

Time Event Ends:*

Rooms Available:

Requested Location: *

Entire Ballroom & Foyer
Large Ballroom 1001A
Small Ballroom 1001BCD
Conference Room 1001B
Conference Room 1001C
Conference Room 1001D
Events Center Foyer - available after 4:00p.m. weekdays.

Services Required - Please check the appropriate boxes

Setup Required:* Yes No

If yes, please select setup (link to typical room set up styles pdf):
Auditorium/Lecture Seated Dinner Conference Standing Cocktail Reception

Foodservice:* Yes No

Breakfast Lunch Dinner Reception
Other, please explain

Will alcohol be served:* Yes No

After hours access?* Yes No (Normal building hours are 6:00 a.m. to 6:00 p.m)

Rental Equipment: * Yes No
Additional services are available. Contact AAA Rental at 339-3707

Audio Visual Set-up:* Yes No (link to Audio Visual equipment fees)

If yes, select available AV equipment:

Full Audio Visual package
Multimedia "Smart" Podium - Microphone, PC, DVD, VCR on cart
Podium with Microphone
Large Projection System - LCD Projector/Cart/Large 16' x 20' Screen
Small Projection System - LCD Projector/Cart/Small 5' x 5' Screen
Wireless/Lavaliere Microphone or hand held microphone with or without stand
Technical Assistance to Get Started

Bring own Laptop
Internet Access
CD Player
Other

How will guests arrive:* Car/Van Bus Other

Will guests need on campus parking:* Yes No

Special requests:

Date: 06/19/2013

Thank you! An acknowledgment of your request and an estimated quotation for your event will be sent to you at the e-mail address you have provided within 48 hours. We will hold the date for you for one week. If you do not confirm your reservation within that time, your reservation will be cancelled and the room will be made available to others.

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