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Breakout - Special Event - Receptions AV
Select an Event
Select an Event
2026 Big West Institute - Phoenix
2026 District 5030 Conference
2026 District 5050 Conference
2026 NW PETS Seattle
2026 Rotary International Conference
2027 NW PELS
Rotary District 5190 Conference
Zone 26-27 Institute - Albuquerque
Date
MM slash DD slash YYYY
Are you an active Rotarian?
(Required)
YES
NO
If "YES", please select your District number
(Required)
Not Currently a Rotary Member
Other
5000
5020
5030
5080
5100
5110
5130
5150
5160
5180
5190
5220
5230
5240
5280
5320
5330
5340
5390
5400
5420
5440
5450
5470
5495
5500
5520
5730
Your Name
(Required)
Your Cell Phone
(Required)
We will use this number to call you if we need more information. This will also be used as your emergency contact number.
Your Email Address
(Required)
Your information is kept strictly confidential.
Your Arrival Date
(Required)
MM slash DD slash YYYY
Your Departure Date
(Required)
MM slash DD slash YYYY
Are you staying at the conference hotel?
(Required)
YES
NO
Your Event Name
(Required)
Event Date
(Required)
MM slash DD slash YYYY
Event Start Time
Hours
:
Minutes
AM
PM
AM/PM
End Time
Hours
:
Minutes
AM
PM
AM/PM
What is the Room or Location of Your Event? (If known)
Number of Attendees (If known)
Number of Mic Floor Stands
Number of Wired Mics
Number Handheld Wireless Mics
Number of Lapel Mics
Lectern
YES
NO
NO PREFERENCE
Lectern Mic
YES
NO
Visual Requirements
Screen Package (Projector, Table, Electricity, Screen)
Need Audio Connection to Computer for Video and/or PowerPoint
Other A/V Requirement Needed -- See Comments, Below
Upload Your Presentation
Drop files here or
Select files
Accepted file types: ppt, pptx, doc, docx, xls, xlsx, mov, mp4, pdf, Max. file size: 256 MB, Max. files: 5.
Please make sure your PowerPoint is formatted in WIDE SCREEN HD FORMAT. If videos are included in your presentation, they must be inserted from the local hard drive, we cannot support online, streaming videos.
This Event will Be Hybrid
YES
NO
Interactive with local and online audience.
This Event will be Streaming
YES
NO
One-way, non-interactive broadcast.
Seating
Theater Seating
Classroom Seating
Hollow Square to Fit Room
U Shaped
Round Dining Tables
Round Cocktail Tables
No Seating Required
Number of Chairs (Theater Seating)
Number of Chairs (Classroom Seating)
Front Riser (Stage) Requested
YES
NO
Depth in Feet
Width In Feet
Need Items On Stage Requested
YES
NO
SEE COMMENTS BELOW
# Chairs on Riser
# Stools on Riser
# Tables on Riser
Comments
Please enter any additional details that will help us support you and make your event a great success!
The Fields Below are Internal Use Only
Please skip over these internal fields and submit the form when you're ready.
GETS - GNATS - ZONE
DIVISION
EPS #
BEO #
Division Chair / Co-chair Approval
