EmailMe Form - Program Submission Form

Name *

First Last

Email *

Phone

### - ### - ####

Building

Program Title *

Program Location

Date and Time of program *

MM / DD / YYYY HH : MM AM/PM

Lead Sponsoring RA *

Assisting RA's

Program Category *

Program Discription *

Are you using an outside presenter ... if yes who

Estimated Cost

Items needed for the program (be specific) and include estimated cost per item *

Program Flyer --- must be in a jpeg format *

Program Flyer --- must be in a jpeg format