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Wednesday, September 08, 2010

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SDSC CI Channel Video Service Request

CI-Channel Service Request Form
CI Channel Service requests need to be made two weeks in advance for at-SDSC locations and one month in advance for non-SDSC locations.  Please fill out the following form as completely as possible adding as much information into your request so that we can better accommodate your needs.  Thank you.
NOTE: Required fields are marked with an asterisk (*)

1) Event Title* (ex.: title of the workshop, group seminar series or event):
(max 100 characters)

Skip to #5 (Date) if the event you are requesting coverage is a series of talks like a week long workshop, conference or seminar series.

2) Title of Presentation/Talk Title:
3) Presenter's First Name*: 4) Presenter's Last Name*:

5) Event Date*


6) Time*:
All day event
Timed event
Duration: Hours Minutes

7) Recurrence*:
does not repeat
event repeats every
event repeats on   of the month every   month(s)

8) End Date*:

 no end date

9) Event Location* (Venue):
10) Street Address:
11) City: State:     
12) Zip Code:      

13) Description of the event*:


14) Event Type:

15) Event Category*:

16) Target Audience:
Please select all those appropriate :
      CI-Partnership Colleagues
      General Public
      Government Agencies
      Scientists - Single Domain
      Scientists - Multiple Fields
      Teachers
      Students - Undergraduate
      Students - Graduate
      Students - Pre-College

17) Permission:
If you would like your event to be password protected, choose private.

18) Presentation Abstract(s):

19) Special equipment required: (additional microphone or camera for Q&A)

20) Event/Project Website (url)*:
21) Event Contact Person *:
22) Event Contact Phone* (ex: ###-###-####):
23) Event Contact Email* (ex: chairman@group.com):
24) Presenter(s) Biography URL(s):
25) Choose One of the following services: (More Info)


26) Payment Method:

27) Index Number:   (official index number to be billed)

28) Email list of contact(s) for announcement when the event goes live:

29) Join Mailing List:    
30) Agree To Terms & Conditions:  
31) To prevent automated entries, we ask that you rewrite the following proverb with its correct spelling in the box below*: (the periods are not required)
An alppe a day .kpees the dcotor aawy.