IP Videoconferencing Request Form

How often do you expect to need the video conferencing facility?

Once

Multiple times - series

List the date(s) with start and end times.

Local Contact Name (within Johns Hopkins)

Local Contact Phone

Local Contact Email

Additional Local Contact Name (optional)

Additional Local Contact Phone (optional)

Additional Local Contact Email (optional)

How many participants will be at the local site?

Less than 15

More than 15

Remote Site Organization

Remote Site Contact Name (Technical person responsible for the videoconference from the other location)

Remote Site Email

Remote Site Phone Number

Remote Site videoconference IP address

Emergency phone number or conference room phone number

Will there be slide presentations?

Yes, local

Yes, remote

Not sure

How many sites will participate in the videoconference?

Cost Center or Internal Order Number

Fund Number

Please use this space for additional information, remote sites, equipment test dates, firewall restrictions, or questions

Fields marked with

are required.