2016 NCAAHPERD-SM Convention Social Event Request Form

The deadline for submitting a Social Event Request is October 1, 2016

Fill out this form, then click the "Submit" button at the bottom of the page.

For the best results, please respond to all registration items. You may respond "NA" to any items that are not applicable to you.

Each Social Event Request submitted must be confirmed by the requesting association's president or by an NCAAHPERD official empowered to approve the Social Event Request.

Lead Presenter's Title:

Planner's First Name:

Planner's Last Name:

Lead Presenter's Company/School/Organization:

Planner's Email Address:

Lead Presenter's Phone Number:

Planner's Position on NCAAHPERD Board:

Name of Event (In title case, exactly as it should appear in the program):

Association or Organization (Select one):

If you selected "Other Association or Organization" from the choices above, please specify the other association or organization.

Event Description (25 words or less to describe this event in the program book):

Contributors (As it should appear in the program book):

Program Type:

Expected Attendance (Enter a number):

	Yes	No
Should this event be listed in the Convention Program?
Will food and beverages be ordered for this meeting?
Is this event open to all convention attendees? If not, it will be listed as "Invitation Only" in the convention program.

Facility Request - 1st Choice:

Facility Request - 2nd Choice:

Planner is responsible for making arrangements for off-site locations.

Define "Other" Facility (if appropriate):

Scheduling Preferences (optional):

Preferred Date:

Preferred Start Time (Please specify AM or PM):

Preferred End Time (Please specify AM or PM):

Alternate Date and Time (Please specify AM or PM):

Equipment Requests: Audio-visual and sound equipment will be provided for social events at the sponsoring group's expense. If you require equipment, the requested equipment will be made through your banquet event order to the hotel.

List your equipment requests, if any:

Are there any special requirements that will affect the size of the room assigned for this event, or are there any other special instructions? If so, please explain:

Important information for NCAAHPERD planners.
All planners listed on this submission MUST agree to the following:

All NCAAHPERD speakers, presenters, and participants attending the NCAAHPERD Convention are responsible for their own expenses to the convention, including registration, travel, and hotel.
All speakers, presenters, and participants in the fields of AHPERD are required to register.
All speakers, presenters, and participants at the NCAAHPERD Convention must be available on any of the convention days (i.e., Thursday through Saturday).

By submitting this form, I acknowledge that I am accepting the above stipulations and will communicate those expectation to all attending or assisting me with the planning of this program or event.

Office use only:

2016 NCAAHPERD-SM Convention Social Event Request Form

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