Contact Information

First and Last Name:

Email Address:

Phone Number:

Institution:

Street Address:

City:

State:

Zip Code:

Event Information

Event Name:

Event Date:

Event Start Time:

Event End Time:

Total Number of Sites:

Videoconference Bit Rate:

Would you like this event streamed?

Yes
No

Would you like this event archived?
You can archive without streaming
Yes
No

Event Description: Please describe your event.

Videoconference Layout: How would you like your screen display set-up?

	Voice Activated			One Big, Five Little
	Side-by-Side			One Big, Seven Little
	Two-by-Two			Three-by-Three
	One Big, Three Little

Lecture Mode(The Audience sees only the presenter, while the presenter sees whichever layout option you select above.)

Testing Information:

MAGPI requires that you schedule a minimum of one multi-site test atleast one week prior to your event. As the event coordinator, your site will be responsible for overseeing all testing for all sites participating in your event.

First Test:

Date:

Start Time:

End Time:

Second Test (Optional):

Date:

Start Time:

End Time:

Technical Coordinator Contact Information:

First and Last Name:

Email Address:

Phone Number:

Comments/Special Requests:

Once you hit the "SUBMIT" button, your request will be sent to MAGPI. You should receive an email confirmation within 48 business hours. If you do not receive an email confirmation, your information has not been received. In this event, please contact John Fafalios via email or at 215-573-8583.