Division of IT: Video Services

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Video Conference Request Form

Call (573)882-2000 if you have special circumstances or if you need assistance filling out this form. Be sure to have the appropriate technical information. Required fields are shown in red. All times are Central Time. Please note that after-hours conferences will incur charges. Enter Authorized Signer/MoCodes for after-hours conferences in the "Special instructions" text box.

Requestor/originating site information
Request date:
Requestor name/local participant:
Department/organization:
Requestor phone number:
Requestor email:
Conference information
Conference date:
Conference start time:
Conference stop time:
Conference purpose:	(Include number of local participants)
Special instructions:
Video system: Call (573)882-2000 if you do not know which video system to select. Most conferences will use H.323-SD (standard definition). Only select H.323-HD (high definition) or AGN if the remote sites are compatible. If you select AGN, provide venue name/virtual room under special instructions.
Content (PowerPoint, PDF, etc.):	Yes No
Remote conference site information For AGN conferences, provide information for at least one site.
First participating site:
Participant contact:
Participant contact phone:
Participant contact email:
Technical contact:
Technical contact phone:
Technical contact email:
Second participating site:
Participant contact:
Participant contact phone:
Participant contact email:
Technical contact:
Technical contact phone:
Technical contact email:
Third participating site:
Participant contact:
Participant contact phone:
Participant contact email:
Technical contact:
Technical contact phone:
Technical contact email:
Fourth participating site:
Participant contact:
Participant contact phone:
Participant contact email:
Technical contact:
Technical contact phone:
Technical contact email:
Fifth participating site:
Participant contact:
Participant contact phone:
Participant contact email:
Technical contact:
Technical contact phone:
Technical contact email:
Technician comments: