Video Conference Events Directory Form

Step 1:

Today's Date:

Action:

New

Change

Cancel

If Change/Cancel, provide event ID:

Step 2:

If Previously registered	Organization ID: Organization Site ID (if organization has multiple sites): Organization Billing ID (If different from organization or Site ID):
If not previously registered	Organization Name: Contact Name: Phone No.: (including area code) Fax No.: (including area code) E-mail:
If not previously registered	Participants Payment Form (The following information is not required if you are charging the participants directly or if the event is free of charge. The following applies to event charges only or event charges bundled with videoconferencing charges). Event Charges: Separate Bundled with videoconferencing charges Fee per site: (event charges per site regardless of number of participants in the site) Fee per participant: Other Fees: Accepted Form of Payment: Billing Contact Name: Billing Address: City: State: Zip: Country:

Step 3:

Event Info:

Event Title:

Event Description:

Event Start Date: Start Time: : EST

Event End Date: End Time: : EST

Max. Number of participant sites allowed for this event:

Max Number of total participants allowed in this Event :

Event Registration Deadline: (If you do not specify a deadline, registrations will be accepted up until the start date of the event).

NOTES OR SPECIAL INSTRUCTIONS:

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