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Telepresence Request Form

PLEASE NOTE:
Cancellations received less than one business day prior to the event will be accessed a cancellation charge.
The minumum charge is the length of the requested session plus a 30 minute room setup time.
4VA Events are not assessed a charge.

Requestor name:(required)
Requestor e-mail:(required)
Requestor phone:(required)
Department:

Additional Contact:
Additional e-mail:
Additional phone:

Event Description:
Event Date:(required)
If the event is recurring, please provide the additional dates:
Start Time (EST):(required)
Please use 24-hour time format; no AM/PM
Example: 09:00
End Time (EST):(required)
Please use 24-hour time format; no AM/PM
Example: 21:00

Telepresence Connection Information

Telepresence Hosting Site:
Telepresence Connect Number:
Telepresence Conference ID:

Requested Virginia Tech Locations

  • Torgersen 1100C must be scheduled through the Registrar's office by emailing amyrl@vt.edu
  • Burruss 312 must be scheduled through the Vice President of Information Technology by calling (540)231-4227 or emailing 312Burruss_resreq@vt.edu

Non-Virginia Tech Locations

Please list the other locations you wish to connect to:

Billing Information

Virginia Tech Department Charge

We collect department and fund number for our own records, regardless of whether a charge is assessed. 4VA events will not be assessed a charge.

Department Number:
Account Number:

Non-Virginia Tech department billing (No 3rd Party or International Billing)

Billing Name:
Billing Address:

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