Name of the Group/Organization:
For which quarter?
		Winter 2011
		Spring 2011
		Fall 2011
		January Term 2012
		Spring Semester 2012
Dates/days of week needed? (For special class/workshop.)
Meeting times: (Include a.m. or p.m.)	(beginning-ending)
Number of tables:	1 2 3 4 5 6
Purpose of the group for using the place
Your Name:
Department:
Work Phone:
Home Phone:
e-Mail Address:
Comments or other information:
Red = Required Information