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CONFERENCE REGISTRATION FORM
CLIENT INFORMATION
Primary Contact:
*
Telephone:
*
Email:
*
Secondary Contact:
Telephone:
Email:
Legal Organization or Business Name:
*
Legal Business Physical Address:
*
Legal Business Mailing Address:
*
Organization or Business Description:
Do you have a Northeastern University Sponsor?
*
Yes
No
If Yes, please indicate Name of Sponsor:
CONFERENCE OR EVENT INFORMATION
Conference or Event Title:
*
Event Type:
*
Banquet/Reception
Conference
Lecture/Workshop
Meeting
Other
Event Description:
Primary Event Date:
Start Time:
*
+
*
12 AM
1 AM
2 AM
3 AM
4 AM
5 AM
6 AM
7 AM
8 AM
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
6 PM
7 PM
8 PM
9 PM
10 PM
11 PM
*
00
05
10
15
20
25
30
35
40
45
50
55
End Time:
*
+
*
12 AM
1 AM
2 AM
3 AM
4 AM
5 AM
6 AM
7 AM
8 AM
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
6 PM
7 PM
8 PM
9 PM
10 PM
11 PM
*
00
05
10
15
20
25
30
35
40
45
50
55
Start Setup:
+
12 AM
1 AM
2 AM
3 AM
4 AM
5 AM
6 AM
7 AM
8 AM
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
6 PM
7 PM
8 PM
9 PM
10 PM
11 PM
00
05
10
15
20
25
30
35
40
45
50
55
End Breakdown:
+
12 AM
1 AM
2 AM
3 AM
4 AM
5 AM
6 AM
7 AM
8 AM
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
6 PM
7 PM
8 PM
9 PM
10 PM
11 PM
00
05
10
15
20
25
30
35
40
45
50
55
Alternate Event Date:
Start Time:
+
12 AM
1 AM
2 AM
3 AM
4 AM
5 AM
6 AM
7 AM
8 AM
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
6 PM
7 PM
8 PM
9 PM
10 PM
11 PM
00
05
10
15
20
25
30
35
40
45
50
55
End Time:
+
12 AM
1 AM
2 AM
3 AM
4 AM
5 AM
6 AM
7 AM
8 AM
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
6 PM
7 PM
8 PM
9 PM
10 PM
11 PM
00
05
10
15
20
25
30
35
40
45
50
55
Start Setup:
+
12 AM
1 AM
2 AM
3 AM
4 AM
5 AM
6 AM
7 AM
8 AM
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
6 PM
7 PM
8 PM
9 PM
10 PM
11 PM
00
05
10
15
20
25
30
35
40
45
50
55
End Breakdown:
+
12 AM
1 AM
2 AM
3 AM
4 AM
5 AM
6 AM
7 AM
8 AM
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
6 PM
7 PM
8 PM
9 PM
10 PM
11 PM
00
05
10
15
20
25
30
35
40
45
50
55
Adults
Minors (12-18)
Minors (Under 12)
Total Expected Attendance
Adults
Minors (12-18)
Minors (Under 12)
Attendee Mobility Considerations:
SPACE CONSIDERATIONS
Number of meeting rooms requested:
Seating Configuration:
Audio / Visual Needs:
Special room requests:
Other considerations:
AMENITIES & SERVICES
Do you require on-campus parking?
Yes
No
Do you require advertising or signage?
Yes
No
Do you require security?
Yes
No
CATERING
Do you require catering?
Yes
No
Do you intend to serve alcohol?
Yes
No
ATTACHMENTS