Russell Auditorium Request Form
Arizona Department of Emergency & Military Affairs
Requesting Organization:
Today’s Date
Requestor Information
Name Email
Address City State Zip Code
Office Ph
Cell Ph
Point of Contact (POC) Information
Same as above
Name Email
Address City State Zip Code
Office Ph
Cell Ph
Event Details
Date Start Time End Time
# of
Attendees
Activity or Training Event
Comments
FOR USE BY ADMINISTRATIVE SERVICES OFFICE ONLY
Request Approved Yes No (if applicable) Reason: Already booked Maintenance Other
Approved by
Reply sent Yes No Date
Security Required? Yes No Fee: $
I will bring my own A/V equipment (describe below).
I will use existing auditorium A/V sem have no A/V
requirements.
I require A/V support/training.
I do not require A/V support/training.
Not applicable.
Method of payment: Check Cash Cashier’s Check/Money Order Not Applicable
Revised 0
8
/2019
Submit completed form to shannon.e.lancaster.mil@mail.mil Questions? Call (602) 267-2758.
*Are any General Officers invited to attend or attending? Yes: No:
If yes, please explain: _______________________________________________________________
*Are any state or federal elected officials invited to attend or attending?
Yes: No:
If yes, please explain: _______________________________________________________________
I have no A/V requirements.
I will bring my own A/V equipment (describe below).
I will use existing auditorium A/V system.
I require A/V support/training.
I do not require A/V support/training.
Not applicable.
