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Event Reservation Request

Event Name:
Name of Authorized Representative:
Mailing/Billing Address:
City:
State:
Zip:
Working Hours Telephone:
Evening Telephone or Cell:
Fax Number:
Email Address:
Date(s) of the Event:
Expected Attendance:


Facilities/Services Requested
Conference/Meeting Room(s)?	YES	Number Attending:
	NO


Lodging?	YES	Number of Persons:	Number of Nights:
	NO


Dining/Catering?	YES	Number attending:
	NO

CONFIRMATIONS
The submission of this form does not confirm your reservation. Reservation requests must be submitted at least three weeks prior to the date of the event. An agreement including the cost for all requested functions, lodging, food services, technology support, etc., will be developed by the Facilities Manager and presented to the authorized representative at least ten (10) business days prior to the event.

Click the SUBMIT button below and your reservation form will be emailed to the Lake Point Conference Center. If you prefer to mail or fax the form, use your browser's PRINT function to print this completed form and mail or fax it to the address noted below:

Lake Point Conference Center at Arkansas Tech University
153 Lake Point Lane
Russellville, AR 72802
PHONE: 479-356-6244
FAX: 479-356-6239