Department Information

* Department Name:          AU Number:            

* Contact Name:                                     Alternate Contact:   

* Email Address:                                    Alternate Email:       

* Telephone Number:                             Alternate Telephone:

* Conference Date:                            Time Zone:                 CST HST PST MST EST AST  

* Conference Time:                            AM/PM:                           AM PM  

* Length of Call:            (Minutes)

Type of Conference

Attended (Operator Assisted)

    Toll Access

    Toll Free Access

    Dial-out Access

Number of domestic (Toll Free Access) participants:                   

Number of international (Toll Access) participants:                       

Originator/Moderator/Host Name:      

Telephone Number:                              

Special Calling Instructions:                 

Confirmation:                                                 No Yes         Fax   Email                             

Optional Features

Recurring Conference:    Daily    Weekly    Bi-weekly    Monthly  

Recording   CD    Tape    Wav File            Number of copies:

                           Sent via: Fedex    Express Mail    Airborne    Regular mail

                           Shipping account number:

                           Address1

                           Address2

                           City                State        Zip

Participant List

Q&A                        Special Instructions:    

Transcription          Send to email address:

Remote Replay      Start Date:   End Date:

                                      Start Time:   End Time:

Attended Dial-Out Only

Please fill in the names and phone numbers of the participants to call and in the order desired

      Participant Name       Telephone Number    Special Instructions

1  

2  

3  

4  

5  

6  

7  

8  

9  

10

11

12

13

14

15

Opening/closing script for Conference coordinator:

If you have any questions or have not received your confirmation email within 4 business hours, please call us at:

  866-338-6338 or  808-237-2250